JP2001157681A - Transfer apparatus for lumen artificial organ - Google Patents

Transfer apparatus for lumen artificial organ

Info

Publication number
JP2001157681A
JP2001157681A JP2000291056A JP2000291056A JP2001157681A JP 2001157681 A JP2001157681 A JP 2001157681A JP 2000291056 A JP2000291056 A JP 2000291056A JP 2000291056 A JP2000291056 A JP 2000291056A JP 2001157681 A JP2001157681 A JP 2001157681A
Authority
JP
Japan
Prior art keywords
push rod
sheath
distal end
end portion
implant
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
JP2000291056A
Other languages
Japanese (ja)
Other versions
JP2001157681A5 (en
Inventor
Lalith Hiran Wijeratne
ヒラン ウィへランテ，ラリス
Timothy Wade Lostetter
ティモシー ウェイド ロステテール，
Trevor Greenan
グレナン，トレバー
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Medtronic Vascular Inc
Original Assignee
World Medical Manufacturing Corp
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by World Medical Manufacturing Corp filed Critical World Medical Manufacturing Corp
Publication of JP2001157681A publication Critical patent/JP2001157681A/en
Publication of JP2001157681A5 publication Critical patent/JP2001157681A5/ja
Pending legal-status Critical Current

Links

Classifications

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    • A61M2025/1043—Balloon catheters with special features or adapted for special applications
    • A61M2025/1052—Balloon catheters with special features or adapted for special applications for temporarily occluding a vessel for isolating a sector
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/02—General characteristics of the apparatus characterised by a particular materials
    • A61M2205/0266—Shape memory materials
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2210/00—Anatomical parts of the body
    • A61M2210/12—Blood circulatory system
    • A61M2210/127—Aorta
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/10—Balloon catheters
    • A61M25/1018—Balloon inflating or inflation-control devices
    • A61M25/10184—Means for controlling or monitoring inflation or deflation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M29/00—Dilators with or without means for introducing media, e.g. remedies
    • A61M29/02—Dilators made of swellable material

Abstract

PROBLEM TO BE SOLVED: To provide a leakage preventing tube capable of being arranged percutaneously by an arranging means having a small cross-sectional area and passed through a lesion region without being sutured or held. SOLUTION: A flexible and compressible push rod is provided and necessary force is applied by the push rod to pass a catheter through a meandering blood vessel to operate the same.

Description

【発明の詳細な説明】DETAILED DESCRIPTION OF THE INVENTION

【０００１】本願は、1998年２月２日に提出された同時
に係属している米国出願No. 09/017,474の一部継続出願
であり、米国出願No. 09/017,474は、1996年９月18日に
提出され、現在は米国特許No. 5,713,917になっている
米国出願No. 08/710,460の一部継続出願である。また、
米国出願No. 08/710,460は1995年10月30日に提出され、
現在は米国特許No. 5,591,195になっている米国出願No.
08/549,880の一部継続出願である。[0001] This application is a continuation-in-part of co-pending US application Ser. No. 09 / 017,474 filed Feb. 2, 1998, which is filed on Sep. 18, 1996. It is a continuation-in-part of U.S. Application No. 08 / 710,460, filed on Nov. 5, which is now U.S. Patent No. 5,713,917. Also,
U.S. Application No. 08 / 710,460 was filed October 30, 1995,
U.S. Application No., now U.S. Patent No. 5,591,195.
08 / 549,880 is a continuation-in-part application.

【０００２】[0002]

【発明の背景】A. 発明の分野 この発明は動脈瘤治療のための血管移植システムに関
し、特に、患者の大腿動脈から経皮導入して血管内で移
植片を配置することによって大動脈瘤を治療するカテー
テルを使用する移植システムに関する。 B. 従来技術の記載 大動脈瘤は、典型的には、大動脈−腎動脈結合部と大動
脈−腸骨動脈結合部との間の領域で動脈血管壁が弱くな
ったり拡張したりすることによって現れる、非常に一般
的な型の悪化性疾患である。動脈瘤は流体を導通させる
管腔の能力に悪影響を及ぼすことが多く、例えば、血管
の破壊が起こった場合など、時として生命を脅かすこと
もある。動脈瘤の標準的な処置法は動脈瘤を部分的にま
たは全て外科的に除去して、血管に代替器官部を移植す
る方法である。しかしながら、このような手術は、動脈
瘤の直径が５cmを越えて大きくなるまで行われないのが
普通である。直径５cmを越える動脈瘤があると、動脈瘤
の外科的切除および移植本来の危険よりも合併症の危険
が大きくなる。その結果、直径が５cmよりも大きな動脈
瘤、および急速に大きくなっている動脈瘤は、破裂する
前に、一般に外科的に除去され、移植されるのが当然の
こととなっている。BACKGROUND OF THE INVENTION A. Field of the Invention The present invention relates to a vascular graft system for treating an aneurysm, and more particularly, to treat an aortic aneurysm by percutaneously introducing the patient from the femoral artery and placing the graft in the blood vessel. The present invention relates to an implantation system using a catheter. B. Description of the Prior Art Aortic aneurysms are typically manifested by weakening or expanding arterial vascular walls in the area between the aortic-renal artery junction and the aortic-iliac artery junction. It is a very common type of deteriorating disease. Aneurysms often adversely affect the ability of the lumen to conduct fluid and can be life-threatening at times, for example, when blood vessel destruction occurs. The standard treatment for aneurysms is to surgically remove some or all of the aneurysm and implant a replacement organ into a blood vessel. However, such surgery is usually not performed until the diameter of the aneurysm has grown beyond 5 cm. The presence of an aneurysm greater than 5 cm in diameter increases the risk of complications beyond the inherent risks of surgical resection and implantation of the aneurysm. As a result, aneurysms larger than 5 cm in diameter, and rapidly growing aneurysms, are generally to be surgically removed and implanted before rupture.

【０００３】大動脈瘤を治療する標準的な方法では、入
院の前に大腸および小腸の状態を整えるのに１日または
２日を要する。手術そのものは、通常、１〜３時間を要
し、数単位の輸血を必要とする。患者は手術の後、通
常、数日間は入院したままで、仕事に戻る前に３ヶ月ほ
どの回復時間を必要とする。さらに、この標準的な方法
に係る死亡率および罹病率は、相変わらず非常に高い。
死亡率は８％もあり、一方、罹病率は血液損失、呼吸路
感染、創傷感染、移植感染、腎不全および腸内出血によ
る虚血のようなよくある合併症を含む。大動脈瘤患者は
年輩であることが多く、麻酔を含む大手術に耐える力が
弱いという事実が、この種の大手術の死亡率および罹病
率に影響していることが多い。[0003] Standard methods of treating aortic aneurysms require one or two days to condition the large and small intestines before hospitalization. The operation itself usually takes 1 to 3 hours and requires several units of blood transfusion. Patients usually remain hospitalized for several days after surgery and require about three months of recovery time before returning to work. Furthermore, the mortality and morbidity associated with this standard method is still very high.
Mortality is as high as 8%, while morbidity includes common complications such as blood loss, respiratory tract infection, wound infection, transplant infection, renal failure and ischemia due to intestinal bleeding. Aortic aneurysm patients are often older and the fact that they are less able to withstand major surgery, including anesthesia, often affects the mortality and morbidity of this type of major surgery.

【０００４】動脈瘤を治療する他の処置方法は大腿動脈
からカテーテルを介して動脈瘤のある位置に移植片を配
置することを含む。しかしながら、従来の管状大動脈置
換部品は、一般に、大腿動脈よりもその直径がかなり大
きく、それ故に、大腿動脈管から挿入して動脈瘤の位置
に送ることができない。それぞれ Choudhury と Kornbe
rg とによる米国特許番号 No. 4,140,126 と No. 4,56
2,596 とに示されているように、カテーテルによる搬送
および配置に適した拡大可能な移植装置が提案されてい
るが、該装置の拡大構造は扱いにくく、操作が難しい。[0004] Another procedure for treating aneurysms involves placing a graft from the femoral artery via a catheter at the location of the aneurysm. However, conventional tubular aortic replacement components are generally much larger in diameter than the femoral artery and therefore cannot be inserted through the femoral artery tract and delivered to the location of the aneurysm. Choudhury and Kornbe respectively
US Patent Nos. 4,140,126 and 4,56 by rg
As shown in US Pat. No. 2,596, an expandable implant device suitable for delivery and placement by a catheter has been proposed, but the expanded structure of the device is cumbersome and difficult to operate.

【０００５】Lazarus に与えられた米国特許 No. 5,10
4,399 は、その基部および末端部に血管内に移植片を固
定するための留具を有している人工移植片、並びに移植
片をそこから展開する管状カプセルを含むカテーテルを
基本とする配置システムを開示している。移植片は予め
選択された断面と長さとを有しており、該移植片を血管
の内面に収容されるように十分に変形させることができ
る。[0005] US Patent No. 5,10 to Lazarus
No. 4,399 describes a catheter-based deployment system including a prosthetic graft having a fastener at its base and distal end for anchoring the graft within a blood vessel, and a tubular capsule from which the graft is deployed. Has been disclosed. The implant has a pre-selected cross-section and length, and can be sufficiently deformed to accommodate the implant on the interior surface of the vessel.

【０００６】Maginot に与えられた米国特許 No. 5,30
4,220 および KwanGett に与えられた米国特許 No. 5,1
51,105 のように、他の移植システムの多くは、移植片
を取り付けるための更なる縫合や他の方法を必要とす
る。さらに、移植片が一度管腔内に配置されると、調整
のためには、通常、大きな外科的処置を必要とする。[0006] US Patent No. 5,30, issued to Maginot
4,220 and U.S. Patent No. 5,1 to KwanGett
Many other implantation systems, such as 51,105, require additional suturing or other methods to attach the implant. Further, once the implant is placed in the lumen, adjustment typically requires extensive surgical procedures.

【０００７】さらに、従来技術のステンレスまたはエル
ジアロイ（elgialloy）ステント移植片は高い漏出率を
有している。また、ステンレスのステント移植片を使用
すると破裂の発生率が高くなる。In addition, prior art stainless steel or elgialloy stent-grafts have high leakage rates. Also, the use of stainless steel stent grafts increases the rate of rupture.

【０００８】共通領域での移植片に関する更なる問題
は、漏出、遊走および血栓症の原因となる移植片の折り
重なりである。米国特許第5,507,771号などに示されて
いる共通領域の移植片であっても、バネの形状とシール
力とによりまっすぐな表面に対してのみ十分なシールを
与えることができる。[0008] A further problem with grafts in common areas is graft folds that cause leakage, migration and thrombosis. Even the implants in the common area, such as those shown in U.S. Pat. No. 5,507,771, can provide sufficient sealing only to straight surfaces due to the spring shape and sealing force.

【０００９】動脈瘤が大動脈から延びる同側、および対
側性の腸骨動脈に生じている場合は、同側肢および対側
肢と連結した主肢を有する略Ｙ形の分岐移植片を使用す
ることが知られている。そのような移植片の例、および
外科的に該移植片を移植する手段はChuterに与えられた
米国特許第5,387,235に記載されている。Chuterによっ
て教示されている外科的方法は、鼠けい部中の大腿血管
を外科的に分離して血管に直接処置を施すか、同側の大
腿動脈および対側の大腿動脈の両方からの経皮的導入の
いずれかが必要である。When an aneurysm occurs in the ipsilateral and contralateral iliac arteries extending from the aorta, a generally Y-shaped bifurcated graft having a main limb connected to the ipsilateral limb and the contralateral limb is used. It is known to Examples of such implants and means for surgically implanting the implants are described in U.S. Patent No. 5,387,235 to Chuter. The surgical methods taught by Chuter include surgical isolation of the femoral vessels in the rat cervix and direct treatment of the vessels, or percutaneous transcutaneous administration from both the ipsilateral and contralateral femoral arteries. One of the strategic introduction is necessary.

【００１０】移植片を取り付けるのに伴う伝統的な外科
的手続および更なる複雑な手続に係る困難は、動脈瘤の
治療を非常に高価で時間のかかる手続にしている。した
がって、その取付のために別の縫合や留付を要せずに所
定の場所に留まることのできる移植片の安全で経皮的な
配置方法を提供しつつ、最小限の準備と外来患者管理し
か必要としない動脈瘤の処理方法が必要とされている。[0010] The difficulties associated with traditional surgical procedures and the more complex procedures associated with implant placement make the treatment of aneurysms a very expensive and time consuming procedure. Thus, there is minimal preparation and outpatient management while providing a secure and percutaneous method of placing the implant that can stay in place without requiring additional suturing or fastening for its attachment There is a need for a method of treating aneurysms that only requires an aneurysm.

【００１１】[0011]

【発明の要約】したがって、本発明の目的は、断面積の
小さい配置手段によって経皮的に配置可能であると共
に、縫合や留付をすることなく病変領域を通る漏出防止
管を与える移植片を提供することである。SUMMARY OF THE INVENTION It is, therefore, an object of the present invention to provide an implant which can be percutaneously positioned by means of a small cross-sectional area and which provides a leak-proof tube through the lesion area without suturing or fastening. To provide.

【００１２】本発明のまた別の目的は単一の導入位置か
ら挿入して配置することのできる分岐移植片を与えるこ
とである。Yet another object of the present invention is to provide a bifurcated implant that can be inserted and placed from a single entry point.

【００１３】本発明のさらにまた別の目的は、先に配置
した移植片と結合する長さ調節延長移植片を提供するこ
とである。It is yet another object of the present invention to provide a length-adjustable extension graft that mates with a previously placed graft.

【００１４】本発明のまた別の目的は、経皮的導入を介
して確実に移植片を配置することのできる嵩張らない移
植片配置手段を提供することである。Yet another object of the present invention is to provide a non-bulky implant placement means that can reliably place the implant via percutaneous introduction.

【００１５】本発明の他の目的は、移植片のバネ部を血
管内面と一致して固定させ、挿入を容易にするように血
管を拡張させ、移植片の配置中に血管を通る血流を制御
する、膨張および縮小可能なバルーンを有する配置手段
を提供することである。Another object of the present invention is to fix the spring portion of the graft in line with the inner surface of the blood vessel, dilate the blood vessel to facilitate insertion, and reduce blood flow through the blood vessel during placement of the graft. It is to provide a deployment means with a controlled, inflatable and deflated balloon.

【００１６】本発明の別の目的は、最小の切開で確実に
移植片を配置する改良された方法を確立することであ
る。Another object of the present invention is to establish an improved method for reliably placing an implant with a minimum incision.

【００１７】本発明のまた別の目的は、患者の死亡率お
よび罹患率が低い移植片の移植方法を確立することであ
る。Yet another object of the present invention is to establish a method of implanting a graft with low patient mortality and morbidity.

【００１８】本発明のさらにまた別の目的は、通常の外
科的移植方法で必要とされるよりも入院および外来での
治療が少なくて済む移植片の移植方法を確立することで
ある。Yet another object of the present invention is to establish a method of implanting a graft that requires less hospitalization and outpatient treatment than required by conventional surgical implantation methods.

【００１９】本発明の別の目的は、分岐移植片を配置す
るための単一導入口法を確立することである。Another object of the present invention is to establish a single entry point method for placing bifurcated grafts.

【００２０】本発明のまた別の目的は、不適切に配置さ
れた移植片を容易に調整または除去する方法を提供する
ことである。It is yet another object of the present invention to provide a method for easily adjusting or removing an improperly placed implant.

【００２１】本発明は、動脈瘤の位置で配置手段によっ
て経皮的に配置することのできる移植装置によって特徴
付けられる動脈瘤治療システムに関する。ここで使用さ
れる「中央部側」という用語は比較的心臓に近いことを
意味し、「末梢側」という用語は心臓から離れているこ
とを意味する。The present invention relates to an aneurysm treatment system characterized by an implantable device that can be percutaneously deployed by a deployment means at the location of an aneurysm. As used herein, the term "central" means relatively close to the heart, and the term "distal" means remote from the heart.

【００２２】本発明の移植装置は、流体を案内する生適
合性移植材料で形成された管状の移植片を有しており、
直線状の単一肢移植片の形状であっても、主肢に一対の
側方肢、即ち同側肢および対側肢が連結した略Ｙ形の分
岐移植片の形状であっても良い。分岐移植片の側方肢、
および接続部の末梢側端部から同軸的に延びる長さ調節
部と連結するための単一肢延長移植片も本発明の範囲内
に入る。移植材、好ましくはポリエステルまたはポリテ
トラフルオロエチレン（PTFE）織材の薄壁は、移植片が
血管の内壁に適合するように大きく変形することがで
き、好ましくは各肢の中央部が細くなるように選択され
る。しかしながら、微細孔ポリウレタン、リクラ（lycr
a）、または低温で貯蔵された外植血管を含む他の被覆
材を使用することもできる。被覆材の最も好ましい態様
は、上記腎動脈固定用に裸のニチノールの正弦波状延長
部を中央部側先端に有する、外側がリクラ（lycra）で
内側がPTFEであるものである。さらに、拍動当たり約 3
MMSの大動脈壁動がある大動脈部では、ポリエステル
（Dacron）が好ましい被覆部材である。さらに、壁動が
殆どない腸骨動脈部で使用される移植片に関しては、PT
FEが好ましい移植被覆材である。延長移植片の長さ調節
部においては、移植材は、その軸方向または長さ方向の
延長および圧縮を可能にするために、波形が付けられて
いる。The implant device of the present invention has a tubular implant formed of a biocompatible implant material for guiding fluid,
It may be in the form of a straight single limb graft, or may be in the form of a substantially Y-shaped bifurcated graft in which the main limb is connected to a pair of lateral limbs, i.e. The lateral limb of the bifurcated graft,
A single limb extension implant for coupling with a length adjustment coaxially extending from the distal end of the connection is also within the scope of the invention. The thin wall of the graft material, preferably a polyester or polytetrafluoroethylene (PTFE) woven material, can be significantly deformed so that the graft fits the inner wall of the blood vessel, preferably so that the center of each limb is thinner Is selected. However, microporous polyurethane, lycra (lycr)
a) or other dressings including explants stored at low temperatures can also be used. The most preferred embodiment of the dressing is a lycra on the outside and PTFE on the inside having a sinusoidal extension of bare Nitinol at the center tip for fixation of the renal artery. In addition, about 3 per beat
Polyester (Dacron) is the preferred coating in the aortic region with MMS aortic wall motion. In addition, for implants used in the iliac artery with little wall motion, PT
FE is the preferred implant dressing. In the length adjustment of the extension implant, the implant is corrugated to allow its axial or longitudinal extension and compression.

【００２３】移植装置は、関係する移植片肢または放射
状に広がって血管の内壁に一致して固定される肢部の中
央部側端部および抹消側端部を偏向させ、好ましくは、
接続棒で連結されている、同軸的に間隔を置いて配置さ
れている一対の管状バネを有するニチノールワイヤバネ
の形状をしており、放射状に圧縮することのできるバネ
手段を含んでいる。延長移植片においては、長さ調節部
の抹消側端部に、同様の偏向を与えるという目的で対に
なっていない環状バネ部が配置されている。各ワイヤバ
ネは移植材で覆われて縫い付けられており、ワイヤバネ
のスポークの間の部分は切除されており、放射状に広が
った複数の指状部を形成している。分岐移植片の結合肢
の抹消側端部、および延長移植片の長さ調節部の抹消側
端部は、配置中にそこに取り付けられている各バネ部を
放射状に圧縮した状態または配置装置に搭載された状態
で保持する保持環をそれぞれ備えている。The implant device deflects the central and peripheral ends of the associated graft limb or limb which radiates and is secured to the inner wall of the blood vessel, preferably
It is in the form of a Nitinol wire spring having a pair of coaxially spaced tubular springs connected by connecting rods and includes spring means that can be radially compressed. In the extension implant, an unpaired annular spring portion is disposed at the peripheral end of the length adjustment portion for the purpose of imparting a similar deflection. Each wire spring is covered with a graft material and sewn, and the portions between the spokes of the wire spring are cut away to form a plurality of radially extending fingers. The peripheral end of the bifurcated graft joint limb and the peripheral end of the extension graft length adjuster should be in a state where the springs attached to it are radially compressed during deployment or in a deployment device. Each is provided with a retaining ring that is retained in a mounted state.

【００２４】好ましい態様においては、移植装置は、さ
らに、光分解性ポリマーで形成されていて組織接着剤を
含有している複数の外包を有している。移植片が移植さ
れた後に、この接着剤は光学ファイバースコープによっ
て放出され、移植片の端部を血管の内壁に接着させ、移
植片と血管との間の微細な隙間からの漏出を防止する。
動脈瘤嚢内での凝血を促進するために、医療グレードの
泡沫カフで移植片の中央部を取り囲むのが好ましい。あ
るいは、光活性クリオ沈殿フィブリン糊を刷毛で移植材
の外壁に塗布してもよい。当然のことながら、光が活性
化して硬化させるまでシロップ状のままである。これは
外包の必要性に取って代わることができ、配置中に破れ
て早すぎる時点で接着剤が外包から放出される可能性を
低減することができる。In a preferred embodiment, the implant device further has a plurality of envelopes formed of a photodegradable polymer and containing a tissue adhesive. After the implant has been implanted, the adhesive is released by a fiber optic scope, adhering the end of the implant to the inner wall of the vessel and preventing leakage through the minute gap between the implant and the vessel.
Preferably, a medical grade foam cuff surrounds the center of the implant to promote clotting within the aneurysm sac. Alternatively, photoactive cryoprecipitated fibrin glue may be applied by brush to the outer wall of the implant. Of course, the syrup remains until the light activates and cures. This can replace the need for an outer package and can reduce the likelihood of the adhesive being released from the outer package at the point of premature tear during deployment.

【００２５】本発明の配置手段は、一般に、移植片を滑
らせて収容すると共に該移植片を保持する軸方向に延び
る鞘通路を有する長い鞘導入器、血管内腔で移植片を配
置する前に放射状に圧縮された搭載状態における関連す
るバネ手段、移植片を動脈瘤の位置に案内して血管内腔
の所定位置に配置するのに使用するために鞘通路および
予め搭載された移植片の内側に受け入れられる長い挿入
カテーテル、並びに滑動可能に挿入カテーテル周りに配
置されると共に鞘通路内に受け入れられており、曲がり
くねった血管中を通過して配置中に鞘通路から移植片を
押し出す、可撓性のある圧縮押し棒を有している。配置
手段は、さらに、鞘導入器上のみにスライド可能であっ
て、血流中に流れ込んだ血栓を捕えるように開いた制御
可能な腎臓および腸骨フィルターからなる微栓子フィル
ターを有していてもよい。The deployment means of the present invention generally comprises a long sheath introducer having an axially extending sheath passageway for slidingly receiving and retaining the implant, prior to placing the implant in the vessel lumen. Associated spring means in a radially compressed mounting state, the sheath passageway and the preloaded graft for use in guiding the graft to the aneurysm location and positioning it in the vessel lumen. A long insertion catheter received internally, as well as a flexible, slidably disposed about the insertion catheter and received within the sheath passageway, forcing the graft out of the sheath passageway during deployment through the tortuous vessel. It has a compressible push rod. The deployment means further comprises a micro-obturator filter slidable only over the sheath introducer and comprising a controllable kidney and iliac filter open to capture the thrombus flowing into the bloodstream. Is also good.

【００２６】一態様においては、押し棒は螺旋状のコイ
ル部材を有している。この態様におけるバネ押し棒は堅
さが連続的に変化しており、この配置システムの鞘また
は他の部分のよじれを最小にして、押し棒が曲がりくね
った血管中を柔軟に移動することができるようになって
いる。In one embodiment, the push rod has a spiral coil member. The spring push bar in this embodiment is continuously variable in stiffness to minimize kinking of the sheath or other portions of the deployment system and allow the push bar to move flexibly through tortuous vessels. It has become.

【００２７】本発明の挿入カテーテルは、対捻ニチノー
ル芯ワイヤが埋め込まれており、その長さ方向に延びて
いる３本の内側トラックを有している。第一の内部トラ
ックは、挿入カテーテルを血管内腔を案内する案内ワイ
ヤを受け入れるために、挿入カテーテルの近端部および
遠端部の両方に開口している。第二の内部トラックは挿
入カテーテルの近端部に開口し、移植片に先立って血管
を拡張すると共に配置中に血管を流れる血流を制御する
ために挿入カテーテルの先端部に配されている、膨張・
収縮可能な先端バルーンと流体の連絡を可能にしてい
る。第三の内部トラックは挿入カテーテルの近端部に開
口し、主として、移植片の配置中に血管内表面に対して
移植片のバネ手段を押しつけるための挿入カテーテルの
遠端部付近に配置されている膨張・収縮可能なバルーン
と流体の連絡を可能にしている。[0027] The insertion catheter of the present invention has three inner tracks embedded with a twisted nitinol core wire and extending the length thereof. The first inner track is open at both the proximal and distal ends of the insertion catheter to receive a guidewire that guides the insertion catheter through the vessel lumen. A second inner track opens at the proximal end of the insertion catheter and is disposed at the distal end of the insertion catheter to dilate the vessel prior to the graft and to control blood flow through the vessel during placement. expansion·
It allows fluid communication with the deflated tip balloon. The third inner track is open to the proximal end of the insertion catheter and is primarily located near the distal end of the insertion catheter for pressing the spring means of the graft against the endovascular surface during placement of the graft. It allows fluid communication with an inflatable and deflated balloon.

【００２８】移植片の位置や大きさが不適切であったた
めに予想していなかった漏洩が観察された場合は、配置
した移植片を折り畳んで鞘導入器106に再び搭載するた
めに、任意で、配置手段に巻き取り装置を組み込んでも
よい。この巻き取り装置は鞘導入器に結合されており、
巻き取りシリンダーの周囲に巻き付けられると共に押し
棒の中央軸通路を通って移植片の末梢側バネ部の各頭頂
部に引っかけるように配されている複数の縫合輪を含
む。Ｌ字型ハンドルで巻き取りシリンダーを回転させて
末端側バネを折り畳み、鞘導入器中に引き入れることが
できる。さらに、巻き取り装置にはブレードが備えられ
ており、移植片の再配置や除去が必要ない場合は縫合材
を除去するために各縫合輪を一点で切断する。If unexpected leakage is observed due to improper placement or size of the implant, an optional placement of the implant in place to fold and reload it into the sheath introducer 106 is possible. The winding device may be incorporated in the arrangement means. This winding device is connected to the sheath introducer,
A plurality of suture loops wrapped around the take-up cylinder and arranged to pass through the central axial passage of the push rod and to each crown of the distal spring portion of the implant. The take-up cylinder can be rotated with the L-shaped handle to collapse the distal spring and pull it into the sheath introducer. In addition, the winding device is provided with a blade, which cuts each suture loop at one point to remove the suture when it is not necessary to reposition or remove the implant.

【００２９】本発明の配置手段を用いて、予め測定した
大動脈瘤を治療するために、予め大きさを決定した単一
肢移植片を外科的に移植する方法は、以下のように、要
約される。この技術において公知である蛍光透視または
他のモニター手段を手続の間中使用することを心に留め
ておくこと。The method of surgically implanting a pre-sized single limb graft to treat a pre-measured aortic aneurysm using the placement means of the present invention can be summarized as follows. You. Keep in mind that fluoroscopy or other monitoring means known in the art are used throughout the procedure.

【００３０】第一に、案内ワイヤを大腿部の経皮導入口
を介して血管に導入し、案内ワイヤの遠端部が大動脈−
腎血管結合部を通り過ぎて上がるまで漸次挿入する。次
いで、予め搭載した移植片を取り囲む挿入カテーテル、
押し棒、および鞘導入器を、先端バルーンが大動脈−腎
血管結合部の上方に行くまで、挿入カテーテルの第一内
部トラックを用いて案内ワイヤに従って血管内腔を通し
てゆく。配置手段の挿入中に、血管を広げて挿入を容易
にするために、先端バルーンを少し膨張させてもよい。
そして、正しい配置がなされたら、大動脈−腎血管結合
部直上の大動脈中で先端バルーンを更に膨張させて血流
を遮る。大動脈の血流を遮っておきながら、挿入カテー
テルを回転させて、鞘導入器とその中に入っている圧縮
された移植片が患者の大動脈の曲がりに合わせて最もよ
く収まるようにする。次に、移植片の中央部側端部に連
結しているバネ部を観察して、大動脈−腎血管結合部直
下の位置において血管内で正しい軸配列がなされるよう
にする。First, a guide wire is introduced into a blood vessel through a percutaneous introduction port in the thigh, and the distal end of the guide wire is connected to the aorta.
Gradually insert until it rises past the renal vascular junction. Then, an insertion catheter surrounding the pre-loaded graft,
The push rod and sheath introducer are passed through the vessel lumen using the guidewire using the first inner track of the insertion catheter until the distal balloon is above the aortic-renal vascular junction. During insertion of the deployment means, the distal balloon may be slightly inflated to widen the vessel and facilitate insertion.
Once properly positioned, the distal balloon is further inflated in the aorta just above the aortic-renal vascular junction to block blood flow. While blocking the aortic blood flow, the insertion catheter is rotated so that the sheath introducer and the compressed graft contained therein fit best into the patient's aortic curvature. Next, the spring portion connected to the central side end of the graft is observed so that the correct axial alignment is performed in the blood vessel at a position immediately below the aortic-renal vascular junction.

【００３１】装置の正しい配置と配列とがなされたら、
押し棒をそのままの位置に保った状態で鞘導入器を少し
引いて、移植片の中心部側バネ部を鞘通路の遠端内部か
ら放出し、中心部側バネ部が正しい位置にあることを確
認しながら、血管の内表面に一致するように放射状に外
側に拡張させる。操作者は、目視のために、案内ワイヤ
を第一内部トラックから除去して、第一内部トラックに
差異のはっきりしている媒体を注入したり、超音波画像
カテーテルを配置してもよい。次に、挿入カテーテルを
血管内上方に動かして、移植バルーンを移植片の中心部
側バネ部内に位置させる。移植バルーンを比較的高圧で
膨張させて、中心部側バネ部を血管の内表面にしっかり
と合わせる。ここで、末端側バネ部を含む移植片を完全
に配置するために鞘導入器を更に引くことができる。末
端側バネ部は動脈瘤の下側の健康な領域に配置される必
要がある。Once the correct arrangement and arrangement of the devices has been made,
With the push rod held in the same position, pull the sheath introducer slightly to release the central spring part of the implant from inside the distal end of the sheath passage, and confirm that the central spring part is in the correct position. While checking, expand radially outward to match the inner surface of the blood vessel. The operator may remove the guidewire from the first inner track for injection, inject a well-defined medium into the first inner track, or place an ultrasound imaging catheter for viewing. Next, the insertion catheter is moved upward in the blood vessel so that the implantation balloon is positioned in the center side spring portion of the graft. The implantation balloon is inflated at a relatively high pressure so that the central spring portion is firmly fitted to the inner surface of the blood vessel. Now, the sheath introducer can be further retracted to fully deploy the implant including the distal spring portion. The distal spring must be located in a healthy area below the aneurysm.

【００３２】そして、先端バルーンをゆっくりと縮小す
ることによって、移植片中に血流を静かに導入する。移
植バルーンは、何度かに渡って縮小させ、移植片の中央
軸に沿って少しずつ動かし、移植材のしわを伸ばすため
に再び膨張させる。移植バルーンが末端側バネ部内まで
移植片中を通ったら、再び比較的高い圧力で膨張させて
末端側バネを血管の内表面に一致固定させる。移植片が
意図された位置にないことが観察されたら、本発明の巻
き取り装置を使用して移植片を鞘導入器に再搭載するこ
とができる。Blood flow is gently introduced into the graft by slowly reducing the distal balloon. The graft balloon may be contracted several times, moved slightly along the central axis of the graft, and inflated again to smooth the wrinkles of the graft. Once the graft balloon has passed through the graft into the distal spring portion, it is again inflated with relatively high pressure to conform and secure the distal spring to the inner surface of the blood vessel. If it is observed that the implant is not in the intended position, the winding device of the present invention can be used to reload the implant on the sheath introducer.

【００３３】移植片が正しく配置されたら、配置手段を
患者から完全に引き出し、そして、光学ファイバースコ
ープを大腿部入口から挿入し、組織接着小包に光を照射
することによって小包の高分子材料を分解させて組織接
着剤を放出する。最後に、大腿部導入口を標準的な方法
で処置する。動脈瘤が隔離されたことを確認するため
に、心臓に最も近い移植片の中央部側端部における漏洩
の発生に特に注意して、術後撮影を行ってもよい。Once the implant has been properly placed, the placement means is withdrawn completely from the patient, and the fiber optic scope is inserted through the thigh entrance and the polymeric material of the parcel is illuminated by illuminating the tissue adhesive parcel. Decompose to release tissue adhesive. Finally, the thigh inlet is treated in a standard manner. To confirm that the aneurysm has been isolated, post-operative imaging may be performed with particular attention to the occurrence of leakage at the mid-end of the implant closest to the heart.

【００３４】本発明は、動脈瘤の位置が一方または両方
の腸骨血管に渡っている場合には、予め大きさを決定し
た分岐移植片を外科的に移植する単一導入口法にも関す
る。The present invention also relates to a single entry method for surgically implanting a pre-sized bifurcated graft when the location of the aneurysm spans one or both iliac vessels. .

【００３５】分岐移植片の配置は、対側腸骨血管内で分
岐移植片の対側肢を適切に移植するのに必要な追加手続
があること以外は、単一肢移植片の移植に使用された方
法に類似する方法で行われる。鞘導入器が大動脈中で移
植片の主脚を配置するために引かれると、鞘導入器が移
植片結合部を通り過ぎた時点で、移植片の対側肢が動脈
瘤嚢内にある状態か、対側腸骨血管内で下方を向いた状
態になるように、移植片の対側肢も鞘導入器から放出さ
れる。対側肢の末端側端部にある維持環が該端部のバネ
部の早過ぎる拡大を防いで、対側腸骨血管内で対側肢を
適切に配置させる。The placement of the bifurcated graft is similar to that used for the implantation of a single limb graft, except that there are additional procedures required to properly implant the contralateral limb of the bifurcated graft within the contralateral iliac vessels. This is done in a manner similar to that described. When the sheath introducer is pulled to position the graft's main leg in the aorta, once the sheath introducer has passed the graft junction, the graft's contralateral limb is in the aneurysm sac, The contralateral limb of the implant is also released from the sheath introducer so that it is oriented downward in the contralateral iliac vessel. A retaining ring at the distal end of the contralateral limb prevents the spring portion of the end from prematurely expanding to properly position the contralateral limb within the contralateral iliac vessel.

【００３６】対側肢の配置は、挿入カテーテル、挿入カ
テーテルの第一内部トラックに挿入され、その遠端部に
膨張・縮小可能な先端バルーンを有している変向可能な
案内ワイヤを用いて行われる。まず、移植バルーンを縮
小させ、変向可能な案内ワイヤが挿入されている挿入カ
テーテルを移植片結合部まで引く。案内ワイヤの遠端部
を変向させて移植片の対側肢に向けるのに、ダイヤル制
御を使用する。すると、案内ワイヤは対側腸骨血管内に
深く進入して行くので、その先端バルーンを膨張させて
案内ワイヤを血管内に固定する。その先端バルーンを少
し膨張させて、挿入カテーテルは固定された案内ワイヤ
に沿って移植片の対側肢の中に進入して行く。次いで、
挿入カテーテルの先端バルーンをもう少し大きく膨張さ
せて、血流によって対側肢の移植材を対側腸骨血管内に
落とすようにする。挿入カテーテルの先端バルーンを縮
小させて、維持環によって保持されている対側肢の末梢
側端部のバネ部内に進め、先端バルーンを再び少し膨張
させて末梢側端部と対側肢の末梢側バネ部とを摩擦で保
持し、対側肢の末梢側端部が所望の位置に達するまで挿
入カテーテルを対側腸骨血管内に進入させ、そして、最
終的に先端バルーンを完全に再膨張させて保持環を完全
に拡張するか破壊してバネ部を開放することによって、
対側肢を最終的に所望する位置に動かす。次いで、配置
手段を大腿部導入口から引き出して除去し、大腿部導入
口は標準的な方法で処置する。Contralateral limb placement is accomplished using a deflectable guidewire inserted into the insertion catheter, the first inner track of the insertion catheter, and having a distally expandable and collapsible distal balloon. Done. First, the implantation balloon is reduced, and the insertion catheter with the deflectable guidewire inserted is pulled to the graft junction. Dial control is used to deflect the distal end of the guidewire toward the contralateral limb of the implant. Then, since the guide wire goes deep into the contralateral iliac blood vessel, its distal balloon is inflated to fix the guide wire in the blood vessel. With the tip balloon slightly inflated, the insertion catheter advances along the fixed guidewire into the contralateral limb of the implant. Then
The distal balloon of the insertion catheter is inflated slightly more so that the blood flow drops the contralateral limb implant into the contralateral iliac vessels. Reduce the distal balloon of the insertion catheter, advance it into the spring portion at the distal end of the contralateral limb held by the maintenance ring, slightly inflate the distal balloon again and distal end and distal side of the contralateral limb. The spring portion is frictionally held, the insertion catheter is advanced into the contralateral iliac vessel until the distal end of the contralateral limb reaches the desired position, and finally the distal balloon is completely reinflated. By completely expanding or breaking the retaining ring to open the spring part,
Move the contralateral limb to the final desired position. The placement means is then pulled out of the thigh inlet and removed, and the thigh inlet is treated in a standard manner.

【００３７】疾患の程度が、片方または両方の血管にお
いてより長い移植片肢が必要であるようなものである場
合は、長さ調節可能な延長移植片を側方肢、例えば、分
岐移植片の対側肢に、以下のようにして同軸的に結合す
ることができる。If the extent of the disease is such that one or both vessels require a longer graft limb, an adjustable length extension graft may be used for the side limb, eg, a bifurcated graft. The contralateral limb can be coaxially coupled as follows.

【００３８】延長移植片は対側大腿動脈に設けた経皮導
入口から配置する。対側肢を通って案内ワイヤを分岐移
植片の主肢に向ける。予め搭載した延長移植片を運ぶ配
置手段は、延長移植片の結合部分を、結合部分の中央部
側端部において第一バネ部が対側肢の末梢側端部におけ
るバネ部と重なるように、部分的に分岐移植片の対側肢
内に位置させるように案内ワイヤの方向に向ける。押し
棒が第一バネ部を配置するために固定位置に保持され、
第一バネ部内で移植バルーンを配置するために挿入カテ
ーテルを上方に動かし、第一バネ部を対側肢の内壁に一
致させるように移植バルーンを膨張する間に、鞘導入器
を引くことができる。結合した移植片肢から漏洩しない
ことを確認するために、挿入カテーテルの第一内部トラ
ックを経て差異のはっきりしている媒体を注入する。次
に、結合部分と長さ調節部分との間の結合を定める第二
バネ部と、長さ調節部の末梢側端部にある第三バネ部、
即ち、長さ調節部の放射状に保持された末梢側環状バネ
とを、対側腸骨血管内に放出するために鞘導入器を更に
引く。そして、移植バルーンを縮小させて第三バネ部内
に動かし、長さ調節部の末梢側端部を摩擦によって保持
するために再び少し膨張させる。これで、挿入カテーテ
ルを下方に引くことによって、長さ調節部の末梢側端部
は腸骨下部または下腹部分岐のほぼ直上に配置されるこ
とになる。第三バネ部は、移植バルーンをそこで完全に
再膨張させて、バネ部を取り囲む保持環を拡張ないし破
壊し、第三バネ部を血管の内表面に一致させて固定する
ことによって配置される。移植バルーンを使用すること
によって、延長移植片中の皺は全て除去することができ
る。最後に、血管写確認などによって、漏洩が認められ
なければ、配置手段を抜き出して大腿部導入口を処置す
ることができる。The extension graft is placed from the percutaneous introduction port provided in the contralateral femoral artery. A guidewire is directed through the contralateral limb to the main limb of the bifurcated graft. The arrangement means for carrying the pre-loaded extension graft is such that the connection portion of the extension graft is such that the first spring portion at the center side end of the connection portion overlaps the spring portion at the distal end of the contralateral limb, Orient the guidewire so that it is partially in the contralateral limb of the bifurcated graft. A push rod is held in a fixed position to position the first spring portion,
The sheath introducer can be pulled while moving the insertion catheter upward to position the graft balloon within the first spring portion and inflating the graft balloon to align the first spring portion with the inner wall of the contralateral limb. . A well-defined medium is injected through the first internal track of the insertion catheter to ensure that it does not leak from the connected graft limb. Next, a second spring portion that determines the connection between the connection portion and the length adjustment portion, and a third spring portion at a distal end of the length adjustment portion,
That is, the sheath introducer is further pulled in order to release the radially held peripheral annular spring of the length adjusting portion into the contralateral iliac blood vessel. Then, the implanted balloon is reduced and moved into the third spring portion, and then slightly expanded again to hold the distal end of the length adjusting portion by friction. Now, by pulling the insertion catheter downward, the distal end of the length adjustment section will be placed almost directly above the lower iliac or lower abdominal bifurcation. The third spring portion is positioned by completely re-inflating the implantation balloon therewith, expanding or breaking the retaining ring surrounding the spring portion, and securing the third spring portion to conform to the inner surface of the blood vessel. By using an implant balloon, any wrinkles in the extension implant can be removed. Lastly, if no leakage is found, such as by confirming an angiogram, the placement means can be extracted to treat the thigh inlet.

【００３９】[0039]

【好ましい態様の詳細な記載】添付の図面を使用した以
下の詳細な説明において、本発明の本質および操作方法
について、より完全に記載する。DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS The following detailed description, using the accompanying drawings, more fully describes the nature of the invention and the manner of operation.

【００４０】まず、図１を参照すると、大動脈−腎動脈
結合部16で腎動脈12および14と結合している大動脈10が
示されており、該大動脈は大動脈−腎動脈結合部の下方
で、病域で弱くなって拡大した血管壁によって特徴付け
られる動脈瘤18を有している。本発明によると、動脈瘤
18の部位に長い単一肢管状移植片20が器官装置として配
置され、動脈瘤の部位を通過する流体導管として機能す
ることにより、弱くなった血管壁への血流圧を緩和する
目的を果たしている。この配置条件においては、移植片
20は大動脈10を通る血流の方向に延びる中央長手方向軸
22をなしており、一般に、移植片の中央部側端部28およ
び末梢側端部30を大動脈10の内表面に押しつけて一致固
定させる、放射状に圧縮可能なバネ手段26を包み込んだ
変形可能な移植材24を有している。Referring first to FIG. 1, there is shown an aorta 10 which is connected to renal arteries 12 and 14 at an aorta-renal artery junction 16 which is below the aorta-renal artery junction. It has an aneurysm 18 characterized by a weakened and enlarged vessel wall in the diseased area. According to the present invention, the aneurysm
A long single limb tubular graft 20 is placed as an organ device at 18 sites, serving as a fluid conduit passing through the site of the aneurysm, thereby relieving blood flow pressure to the weakened vessel wall I have. In this placement condition, the graft
20 is the central longitudinal axis extending in the direction of blood flow through the aorta 10
22, generally deformable enclosing radially compressible spring means 26, which presses the central end 28 and distal end 30 of the graft against the inner surface of the aorta 10 to secure them together. It has a transplant material 24.

【００４１】移植材24は、生適合性、可撓性および拡張
性のある孔の少ない織布であり、例えば、大動脈10の内
壁に一致するように大きく変形することができ、さらに
管状になったときには流体導管として働くことのでき
る、薄壁ポリエステルまたはPTFEなどである。中央部側
端部28と末梢側端部30との間にある移植片の中央部29は
細くなっており、端部28および30に比べて流体導通断面
積が小さくなっている。これは、折り重なりや皺の発生
を低減して、移植片をより広い範囲の異なる大きさの血
管に適合させるための手段であって、移植材24の少なく
とも１本の長手方向の構成片を切り取り、結果として生
じる隙間を縫合するなどして形成する。The implant 24 is a biocompatible, flexible and expandable, low-perforated woven fabric that can be significantly deformed to conform to the inner wall of the aorta 10, for example, and is further tubular. Such as thin-walled polyester or PTFE, which can then serve as a fluid conduit. The central portion 29 of the implant between the central end 28 and the distal end 30 is thinner and has a smaller fluid conduction cross-sectional area than the ends 28 and 30. This is a means for reducing the occurrence of folds and wrinkles and for adapting the implant to a wider range of different sized vessels, wherein at least one longitudinal component of the implant 24 is It is formed by cutting out and suturing the resulting gap.

【００４２】移植材24には、中央部側バネ部34と末梢側
バネ部36とを有するニチノールワイヤバネが包み込まれ
ている。あるいは、当該バネ部34が腎動脈12、14に渡っ
て配置されたときに動脈12、14を通る血流が遮断されな
いように、中央部側バネ部34は被覆されていない部分ま
たは移植材の中央部側開領域を有していてもよい。移植
片の端部28および30で、動脈瘤18の上下の大動脈10の内
壁に移植材24を押しつけて一致固定させるために、バネ
部34、36は、約240〜340グラムの放射状外向きの力を及
ぼすように設計されている。バネを形成するのに使用さ
れているニチノールワイヤは弾性力に富み、直線状に焼
鈍した状態にあり、生適合性を向上させ、ニッケルへの
アレルギー反応の発生を低下させ、放射線不透過性を向
上させるために酸化チタンで被覆されていてもよい。血
液の凝固やワイヤの腐食の危険性を低減させるために、
PTFEコーティングを施すこともできる。更なる防止措置
として、被覆をイリジウム192または他の低量のβ線放
出物質で処理して、血管の閉塞につながることがあり得
る血管中での術後細胞増殖を低減してもよい。バネ部34
および36は、中心軸22周りのそれぞれ丸みのある互い違
いの山40および谷42を真っ直ぐなスポーク38が結合して
いるという正弦曲線様の形状のワイヤを一巡させること
によって形成されている。バネの性質をより優れたもの
にすると共にワイヤが尖った移行部を有するのを避ける
ため（尖った移行部を有していると失敗しやすいため）
に、好ましいバネ部は、予め定められた半径で形成され
た、等間隔の５つの山40と等間隔の５つの谷42とを有す
る。同軸的に間隔をあけたバネ部34と36とは、血流を乱
すのを最小限にするために、好ましくは、中心軸22に概
ね平行に延びる少なくとも１本の接続棒44によって連結
されている。接続棒44は移植片20に捻れ安定性を与える
という機能を有し、バネ部34および36に溶接するか、小
さなスリーブ（図示せず）によって留め付ければよい。The implant 24 encloses a Nitinol wire spring having a central spring portion 34 and a peripheral spring portion 36. Alternatively, the central side spring portion 34 may be an uncoated portion or a graft material so that the blood flow through the arteries 12 and 14 is not blocked when the spring portion 34 is placed over the renal arteries 12 and 14. It may have a central side open area. At the ends 28 and 30 of the graft, the springs 34, 36 have approximately 240-340 grams of radially outwardly directed indentation to compress the implant 24 against the inner walls of the aorta 10 above and below the aneurysm 18. Designed to exert force. The nitinol wire used to form the spring is elastic, linearly annealed, improves biocompatibility, reduces the occurrence of allergic reactions to nickel, and reduces radiopacity. It may be coated with titanium oxide to improve. To reduce the risk of blood coagulation and wire corrosion,
A PTFE coating can also be applied. As a further precaution, the coating may be treated with iridium 192 or other low levels of beta-emitting material to reduce post-operative cell proliferation in the blood vessel, which can lead to occlusion of the blood vessel. Spring part 34
And 36 are formed by looping through a sinusoidally shaped wire with straight spokes 38 joining rounded alternating peaks 40 and valleys 42 about a central axis 22 respectively. To improve the properties of the spring and avoid having sharp transitions in the wire (because sharp transitions are prone to failure)
In addition, a preferred spring portion has five equally-spaced peaks 40 and five equally-spaced valleys 42 formed with a predetermined radius. The coaxially spaced spring portions 34 and 36 are preferably connected by at least one connecting rod 44 extending substantially parallel to the central axis 22 to minimize disruption of blood flow. I have. The connecting rod 44 has the function of imparting torsional stability to the implant 20 and may be welded to the springs 34 and 36 or fastened by a small sleeve (not shown).

【００４３】ワイヤバネはポリエステル縫合糸を用いて
移植材24内に縫い付けられる。縫い付けに先立って、ワ
イヤバネを取り囲むように移植材24を配し、約華氏150
度に加熱された弧状の押圧面（図示せず）を用いて、バ
ネ部34および36と一致し、バネ部の湾曲と合うように加
熱押圧される。好適なステッチとしては、ワイヤの両サ
イドに沿って延びる略平行な２本のステッチ、およびワ
イヤバネに移植材24をしっかりと取り付けるために前記
平行なステッチを引き入れてワイヤ周りにかがる交差ス
テッチを挙げることができる。この取り付け方法によっ
て、ワイヤバネと血管の内壁との間の接触を実質的に防
ぐことができ、長時間に渡る信頼性を提供することがで
きる。本発明では、中央部側バネ部34と抹消側バネ部36
との間の山40の間で、移植材24を切除して、移植材端部
28および30において複数の放射状に広がった指状部46を
形成する。重要なことであるが、指状部間の空隙によっ
て血流を妨げないように腎動脈12および14の位置に指状
部を配することができるので、従来技術の移植片構造体
で可能であったよりも、この指状部46によって、移植片
20の中央部側端部28を大動脈−腎動脈結合部16にはるか
に近い部位に位置させることができる。さらに、指状部
46は円錐状の先端に近似するように放射状に圧縮するこ
とができるので、移植片20を鞘導入器内に挿入搭載する
のを容易にする。これについては後述する。大動脈−腎
動脈結合部16と動脈瘤18との間の健康な血管頸部が特に
短い場合には、図２に示されているように、裸のニチノ
ールワイヤ固定バネ48を使用して、移植片20の位置保全
性を向上させることもできる。固定バネ48は、移植片の
中央部側バネ部34から離れた腎動脈上部固定のために、
大動脈−腎動脈結合部16の上方約20 mmsの位置に配され
る中央部側バネ部50と、移植片の中央部29内に縫い込ま
れ、少なくとも１本の軸方向に延びる接続棒54で中央部
側バネ部50と連結された末梢側バネ部52とを有する。従
来技術の移植片システムにおいては約20 mmsの健康な血
管頸部が大動脈−腎動脈結合部の下方に必要であったの
に対して、本発明では約５mmsの健康な血管頸部が必要
なだけであるという点において、放射状に広がる指状部
46と任意使用の固定バネ部48とによって、従来技術の移
植片システムに比べて、はるかに多い数の患者に対して
本発明を使用することができるようになった。The wire spring is sewn into the implant 24 using a polyester suture. Prior to sewing, place the graft material 24 around the wire spring, and
Using an arc-shaped pressing surface (not shown) that is heated each time, it is heated and pressed so as to coincide with the spring portions 34 and 36 and match the curvature of the spring portion. Preferred stitches include two generally parallel stitches extending along both sides of the wire, and cross stitches that draw in the parallel stitches and hang over the wire to securely attach the implant 24 to the wire spring. Can be mentioned. This attachment method can substantially prevent contact between the wire spring and the inner wall of the blood vessel, and can provide long-term reliability. In the present invention, the central side spring portion 34 and the peripheral side spring portion 36
Between the peaks 40 between, the graft 24 is cut off and the graft ends
At 28 and 30, a plurality of radially extending fingers 46 are formed. Importantly, the fingers can be positioned at the renal arteries 12 and 14 so that the air gap between the fingers does not impede blood flow, which is possible with prior art implant structures. This finger 46 makes the graft more
The central end 28 of 20 can be located much closer to the aortic-renal artery junction 16. In addition, fingers
46 can be radially compressed to approximate a conical tip, thereby facilitating insertion and mounting of the implant 20 within the sheath introducer. This will be described later. If the healthy vascular neck between the aortic-renal artery junction 16 and the aneurysm 18 is particularly short, the graft may be implanted using a bare Nitinol wire locking spring 48, as shown in FIG. The position integrity of the piece 20 can also be improved. The fixation spring 48 is used to fix the upper renal artery away from the central side spring portion 34 of the graft.
A central spring portion 50 located approximately 20 mms above the aortic-renal artery junction 16 and at least one axially extending connecting rod 54 sewn into the central portion 29 of the implant. It has a peripheral-side spring portion 52 connected to the central-side spring portion 50. In the prior art graft system, a healthy vascular neck of about 20 mms was required below the aortic-renal artery junction, whereas the present invention requires a healthy vascular neck of about 5 mms. Radially extending fingers in that only
The 46 and optional fixation spring 48 allow the invention to be used on a much larger number of patients compared to prior art implant systems.

【００４４】移植片20は、さらに、端部28および30にお
いて移植材24の外表面に固定された複数の放出可能組織
接着剤小包56を有しており、移植材24と大動脈10の内壁
との間でしっかりとした流体シールを確立している。小
包56は光感応性ポリウレタンで形成することができ、例
えば、フィブリン糊またはイソブチル2シアノアクリレ
ートなどの生適合性組織接着剤で満たされている。この
組織接着剤は配置の間は小包中に完全に包み込まれてお
り、後ほど、光ファイバーカテーテルの光源を移植片20
の内側から小包56に向けて小包材を分解することによっ
て放出される。組織接着剤は、移植材24と大動脈10の内
表面との間にある小さな隙間に入ってそこを占有し、両
者を結合して流体シールを形成する。これによって、漏
出の重大な問題を防ぐことができる。既述の組織接着剤
小包に代わるものとしては、移植材の外表面に塗布され
る光活性クリオ沈殿フィブリン糊の使用を挙げることが
できる。The implant 20 further includes a plurality of releasable tissue adhesive packets 56 secured to the outer surface of the implant 24 at ends 28 and 30 so that the implant 24 and the inner wall of the aorta 10 A solid fluid seal has been established between the two. Parcel 56 may be formed of a light-sensitive polyurethane and is filled with a biocompatible tissue adhesive such as, for example, fibrin glue or isobutyl 2-cyanoacrylate. This tissue adhesive is completely wrapped in the parcel during placement, and the light source of the fiber optic catheter is later implanted into the implant.
It is released by breaking the parcel material from inside the parcel towards the parcel 56. The tissue adhesive enters and occupies a small gap between the implant 24 and the inner surface of the aorta 10 and joins the two to form a fluid seal. This can prevent significant leakage problems. An alternative to the previously described tissue adhesive package is the use of photoactive cryoprecipitated fibrin glue applied to the outer surface of the implant.

【００４５】末端部28および30で使用する組織接着剤小
包56に加えて、医療グレードの膨張性泡沫を有する１以
上のカフ58を中央部29を取り囲むように配し、移植片20
の外側の動脈瘤の空間での凝血を促進することもでき
る。好ましい態様においては、移植片の直径よりも約４
〜10 mms大きく膨張することのできる第一および第二の
カフをバネ部34および36の近傍に配し、移植片の直径よ
りも約10〜40 mms大きく膨張することのできる第三のカ
フを第一および第二のカフの中間に配する。カフ58とし
ては、胎児の内皮細胞、平滑筋細胞、または他の生きて
いる組織細胞と神経膠腫成長因子とをそれぞれ泡沫母材
または光活性泡沫粒子に含ませたものを好適に使用する
ことができ、バネ部34および36近傍での治癒を促すと共
に中央部29付近での動脈瘤嚢18を埋める。In addition to the tissue adhesive packet 56 used at the distal ends 28 and 30, one or more cuffs 58 having medical grade intumescent foam are disposed around the central portion 29 and the implant 20.
It can also promote blood clotting in the space of the aneurysm outside. In a preferred embodiment, the diameter is about 4
The first and second cuffs, which can be inflated by about 10 mms, are placed near the spring portions 34 and 36, and the third cuff, which can be inflated about 10 to 40 mms larger than the diameter of the implant, is provided. Place between the first and second cuffs. As the cuff 58, fetal endothelial cells, smooth muscle cells, or other living tissue cells and glioma growth factor and a foam matrix or photoactive foam particles, respectively, are preferably used. This promotes healing near the spring portions 34 and 36 and fills the aneurysm sac 18 near the central portion 29.

【００４６】図３に示されている分岐移植片60も、腸骨
血管11および13の片方または両方が関係してくる場合に
使用するものとして、本発明の範囲に入る。移植片60は
Ｙ字型をしており、大動脈10中に配置するための主肢62
を有している。そして、移植片結合部63において、同側
腸骨血管11内に配置するための同側肢64と、対側腸骨血
管13内に配置するための対側肢66が結合している。分岐
移植片60の各肢は、各肢の中央部側端部および末梢側端
部がそれに取り付けられた環状バネ部によって対応する
血管の内表面に一致固定されるように押し付けられてお
り、各肢の中央部が細くなっているのが好ましいという
点において、単一肢移植片20に構造が概ね類似してい
る。第一ニチノールワイヤバネは、移植材24に取り囲ま
れ、その内側に縫い込まれている。この第一ニチノール
ワイヤバネは、主肢62の中央側端部に取り付けられた中
央部側バネ部68A、主肢62の抹消側端部に取り付けられ
た抹消側バネ部68B、およびこれら中央部側バネ部と抹
消側バネ部とを連結し、軸方向に延びる接続棒68Cを有
している。同様に、第二ニチノールワイヤバネは中央部
側バネ部70A、抹消側バネ部70B、および軸方向に延びる
接続棒70Cを有し、同側肢64に縫い込まれている。ま
た、第三ニチノールワイヤバネは中央部側バネ部72A、
抹消側バネ部72B、および軸方向に延びる接続棒72Cを有
し、同側肢66に縫い込まれている。分岐移植片60の終端
部、即ち主肢62の中央側端部、並びに側方肢64および66
の抹消側端部には、先に記載した放射状に広がる指状部
46が設けられている。移植片60を配置するために同側の
大腿動脈を介して導入口が設けられる場合は、抹消側バ
ネ部72Bは拡張可能な保持環79によって放射状に圧縮さ
れた状態に保たれる。この保持環は、単に、財布の紐型
の結び目で端と端とを結んで輪を作った一定の長さの縫
合材料であればよく、対側腸骨血管13で移植片を正しく
配置する前に、早すぎる時点で抹消側バネ部72Bが配置
されてしまうのを防ぐ。同様に、対側の大腿動脈を介し
て入口が設けられる場合は、抹消側バネ部70Bは拡張可
能な保持環79によって放射状に圧縮された状態に保た
れ、同側腸骨血管11で移植片を正しく配置する前に、早
すぎる時点で抹消側バネ部70Bが配置されてしまうのを
防ぐ。図３には示されていないが、先に記載した組織接
着剤小包56と泡沫カフ58とを分岐移植片60においても採
用することができるのは当然である。特に、小包56を少
なくとも主肢62の中央部側端部に配するのが好ましく、
また、泡沫カフ58を主肢の周囲に配して動脈瘤嚢18を埋
めるのが好ましい。The bifurcated graft 60 shown in FIG. 3 is also within the scope of the present invention for use when one or both of the iliac vessels 11 and 13 are involved. The graft 60 is Y-shaped and has a main limb 62 for placement in the aorta 10.
have. Then, at the graft coupling portion 63, the ipsilateral limb 64 for disposition in the ipsilateral iliac blood vessel 11 and the contralateral limb 66 for disposition in the contralateral iliac blood vessel 13 are coupled. Each limb of the bifurcated graft 60 is pressed such that the central end and the distal end of each limb are conformally fixed to the inner surface of the corresponding blood vessel by an annular spring attached thereto, The structure is generally similar to the single limb implant 20 in that it is preferred that the center of the limb be tapered. The first Nitinol wire spring is surrounded by the implant 24 and sewn inside. The first nitinol wire spring has a central side spring portion 68A attached to the central side end of the main limb 62, a peripheral side spring portion 68B attached to the peripheral side end of the main limb 62, and It has a connecting rod 68C that connects the spring portion and the peripheral side spring portion and extends in the axial direction. Similarly, the second nitinol wire spring has a center side spring portion 70A, a peripheral side spring portion 70B, and a connection rod 70C extending in the axial direction, and is sewn to the same side limb 64. Also, the third nitinol wire spring has a center side spring portion 72A,
It has an erasing-side spring portion 72B and a connecting rod 72C extending in the axial direction, and is sewn to the same-side limb 66. The end of the bifurcated graft 60, the central end of the main limb 62, and the lateral limbs 64 and 66
At the peripheral edge of the finger, the finger that spreads radially as described above
46 are provided. If an inlet is provided through the ipsilateral femoral artery for placement of the graft 60, the peripheral spring portion 72B is kept radially compressed by the expandable retaining ring 79. The retaining ring may simply be a fixed length of suture material that is looped end-to-end with a purse strap-type knot to properly position the graft in the contralateral iliac vessel 13 Before this, it is possible to prevent the erasure-side spring portion 72B from being disposed too early. Similarly, when the entrance is provided through the contralateral femoral artery, the peripheral spring portion 70B is kept in a radially compressed state by the expandable retaining ring 79, and the graft is inserted into the ipsilateral iliac blood vessel 11 by the graft. This prevents the erasure-side spring portion 70B from being disposed too early before the correct placement. Although not shown in FIG. 3, it should be understood that the previously described tissue adhesive packet 56 and foam cuff 58 can be employed in the bifurcated implant 60 as well. In particular, it is preferable to arrange the parcel 56 at least at the center side end of the main limb 62,
Preferably, a foam cuff 58 is placed around the main limb to fill the aneurysm sac 18.

【００４７】単一肢延長移植片80は、図４に示されてい
るように、本発明のまた別の有用な装置を具体的に示し
ている。延長移植片80は、分岐移植片60の側方肢、例え
ば対側肢66と、端と端とで結合するように設計されてい
る。そして、通常、結合部82と、該結合部の末梢側端部
から同軸的に延びている長さ調節部84とを有している。
結合部82は、結合部82の中央部側端部を対側肢66の内表
面に押し付けて一致固定させる第一バネ部88Aと、接続
棒88Cによって第一バネ部88Aに結合され、結合部82の抹
消側端部および長さ調節部84の中央部側端部を対側腸骨
血管13の内表面に押し付けて一致固定させる第二バネ部
88Bとを有している。対になっていない第三バネ部90は
長さ調節部84の抹消側端部に配され、該端部を対側腸骨
血管13の内表面に押し付けている。第三バネ部90は、配
置に先だって、保持環79に類似した破壊可能な保持環91
で放射状に圧縮された状態に維持されている。長さ調節
部84の移植材に襞があるので、配置中に、第三バネ部90
を所望の位置へと軸の反対方向に動かすことができる。A single limb extension implant 80, as shown in FIG. 4, illustrates yet another useful device of the present invention. The extension graft 80 is designed to connect end-to-end with a lateral limb, for example, the contralateral limb 66 of the bifurcated graft 60. And usually, it has a connecting portion 82 and a length adjusting portion 84 coaxially extending from a distal end of the connecting portion.
The joining portion 82 is joined to the first spring portion 88A by pressing the center end portion of the joining portion 82 against the inner surface of the contralateral limb 66 to fix and match the first spring portion 88A with the connecting rod 88C. A second spring portion that presses the peripheral end of 82 and the central end of the length adjusting portion 84 against the inner surface of the contralateral iliac blood vessel 13 to fix them together
88B. The unpaired third spring portion 90 is disposed at the peripheral end of the length adjusting portion 84 and presses the end against the inner surface of the contralateral iliac blood vessel 13. Prior to deployment, third spring portion 90 includes a breakable retaining ring 91 similar to retaining ring 79.
At a radially compressed state. Due to the folds in the implant of the length adjusting portion 84, the third spring portion 90
Can be moved in the opposite direction of the axis to the desired position.

【００４８】当業者には高く評価されるであろうが、上
記移植片20、60および80は、様々な長さの動脈瘤を治療
することができるように、様々な大きさの血管内に適合
するような大きさに製造することができる。As will be appreciated by those skilled in the art, the grafts 20, 60 and 80 can be used to treat various aneurysms of various lengths in different sized vessels. It can be manufactured to fit size.

【００４９】血管内に移植片を配置する本発明の好適な
装置は図５および６に示されており、全体としては、参
照符号100によって特定されている。配置手段100は、患
者の大腿動脈へ経皮導入して動脈瘤18に移植片を運ぶこ
とができるように長い形状をしており、執刀する外科医
による操作のために、通常、患者の皮膚の外側に出たま
まになっている近端部102と、通常、配置中に血管内腔
を移動して動脈瘤18に移植される移植片を運搬する遠端
部104とを有しているものとして記載される。配置手段1
00は、軸方向に延びる鞘通路108を有する長い鞘導入器1
06、鞘通路108内に緩く収められている長い挿入カテー
テル110、および挿入カテーテル110にスライド可能に取
り付けられると共に鞘通路108内に収められている、長
い圧縮バネ押し棒112を有している。A preferred device of the present invention for placing a graft in a blood vessel is shown in FIGS. 5 and 6 and is generally identified by reference numeral 100. The deployment means 100 is long in shape so that it can be percutaneously introduced into the patient's femoral artery to carry the graft to the aneurysm 18 and, for manipulation by the surgeon performing the procedure, typically requires the removal of the patient's skin. With a proximal end 102 that remains outward and a distal end 104 that typically carries the vessel lumen during deployment to carry a graft to be implanted in the aneurysm 18 It is described as Arrangement means 1
00 is a long sheath introducer 1 having an axially extending sheath passage 108
06, having a long insertion catheter 110 loosely housed within the sheath passage 108 and a long compression spring push rod 112 slidably mounted on the insertion catheter 110 and housed within the sheath passage 108.

【００５０】鞘導入器106は、低摩擦性の可撓材料、好
ましくは、F.E.P.で形成される。しかしながら、PTFEの
代わりにポリウレタン、シリコーン、ポリエチレンまた
は他の類似の材料を使用することもできる。鞘導入器10
6の大きさは、配置される移植片の大きさに基づいて、
血管内に移植片を配置するのに先立ち、放射状に圧縮し
て予め搭載した状態で、該移植片を鞘通路108の遠端部
内に保持できるように選択される。非常に多くの例にお
いて、12 FR、14 FR、16 FR、18 FRおよび20 FRが好適
である。移植片の指状部46は、鞘通路108内への移植片2
0の挿入を容易にするために、円錐の先端状になるよう
に押しまとめることができる。この特長によって、指状
部46がない類似の移植片を搭載するのに比べて、鞘導入
器の断面が２ FR分小さくなる。搭載が完了した移植片
を見て正しい搭載がなされたことを確認するために、鞘
導入器106は透明であるのが好ましい。バネ押し棒112の
周囲に流体シールを形成して患者の入口切開部から血液
が漏出するのを防ぐために、鞘導入器106は、その近端
部に、少なくとも１つのラテックスで被覆した止血弁11
4を備えている。ヘパリン化した溶液または差異のはっ
きりした媒体などの流体を鞘通路108、そして最終的に
は血管に導入するために、サイドポート手段116が設け
られている。サイドポート手段116は、可撓管120を介し
て鞘通路108と通じると共に適当な流体注入手段（図示
せず）を受け入れるようになっている手動操作弁118を
有している。[0050] The sheath introducer 106 is formed of a low friction, flexible material, preferably FEP. However, polyurethane, silicone, polyethylene or other similar materials can be used instead of PTFE. Sheath introducer 10
The size of 6, based on the size of the implant to be placed,
Prior to placement of the graft within the vessel, it is selected to retain the graft within the distal end of the sheath passageway 108 in a radially compressed and preloaded state. In numerous instances, 12 FR, 14 FR, 16 FR, 18 FR and 20 FR are preferred. The implant finger 46 is used to insert the implant 2 into the sheath passageway 108.
To facilitate the insertion of the zero, it can be squeezed into a conical tip. This feature reduces the cross-section of the sheath introducer by 2 FR compared to mounting a similar implant without the fingers 46. Preferably, the sheath introducer 106 is transparent in order to confirm the correct placement by looking at the loaded graft. In order to form a fluid seal around the spring push rod 112 to prevent blood from leaking out of the patient's inlet incision, the sheath introducer 106 has at its proximal end at least one latex-coated hemostatic valve 11.
It has four. Side port means 116 are provided for introducing a fluid, such as a heparinized solution or a well-defined medium, into the sheath passageway 108 and ultimately into the blood vessel. The side port means 116 has a manually operated valve 118 which communicates with the sheath passage 108 via a flexible tube 120 and is adapted to receive a suitable fluid injection means (not shown).

【００５１】８ FR カテーテル管で形成することのでき
る挿入カテーテル110は、鞘導入器106よりも長く、挿入
カテーテルを鞘通路108内に収めたときにその近端部お
よび遠端部が鞘導入器106から突き出している。図６の
断面図に示されているように、挿入カテーテル110は、
抗捻ニチノール芯ワイヤ122が埋め込まれ、第一内部ト
ラック124、第二内部トラック126および第三内部トラッ
ク128を有し、それら全ては長さ方向に延びている。図
５を再び参照すると、流体を第一内部トラック124に導
入する第一端部ポート手段130は、適当な流体注入手段
（図示せず）と累合し、可撓管134を介して第一内部ト
ラック124の近端部と通じるネジ筋を切ったアダプター1
32を有する。第二内部トラック126に流体を導入する第
二端部ポート手段136は、可撓管140を介して第二内部ト
ラックの近端部と通じ、適当な流体注入手段142を受け
入れるようになっている手動操作弁138を有している。
同様に、第三内部トラック128に流体を導入する第三端
部ポート手段144は、可撓管148を介して第三内部トラッ
クの近端部と通じ、適当な流体注入手段150を受け入れ
るようになっている手動操作弁146を有している。The insertion catheter 110, which can be formed of an 8 FR catheter tube, is longer than the sheath introducer 106 and has a proximal end and a distal end when the insertion catheter is placed in the sheath passageway 108. Protruding from 106. As shown in the cross-sectional view of FIG.
An anti-twist nitinol core wire 122 is embedded and has a first inner track 124, a second inner track 126, and a third inner track 128, all of which extend lengthwise. Referring again to FIG. 5, the first end port means 130 for introducing fluid into the first inner track 124 is integrated with a suitable fluid injection means (not shown) and is provided via a flexible tube 134 for the first end port means. Threaded adapter 1 leading to the proximal end of the inner track 124
With 32. A second end port means 136 for introducing fluid into the second inner track 126 communicates with the proximal end of the second inner track via a flexible tube 140 and is adapted to receive a suitable fluid injection means 142. It has a manually operated valve 138.
Similarly, a third end port means 144 for introducing fluid into the third inner track 128 communicates with the proximal end of the third inner track via a flexible tube 148 to receive a suitable fluid injection means 150. Having a manually operated valve 146.

【００５２】発明の好適な態様においては、芯ワイヤ12
2は、挿入カテーテル110の近端部における0.031インチ
の直径から挿入カテーテルの遠端部における0.020イン
チの直径へと次第に細くなっている。この特長によっ
て、挿入カテーテル110の近端部は強く、挿入カテーテ
ルの遠端部は血管の穿刺または破裂を起こしにくいよう
に、しかし、血流の力で大きく逸れることがないように
なっている。挿入カテーテル110に抗捻性と強度とを与
えるのに加えて、芯ワイヤ122においては捻れ剛性が大
きく向上しており、これによって、その長手方向軸周り
の挿入カテーテル110の近端部の回転は、挿入カテーテ
ルの遠端部における実質的に等しい回転に移される。し
たがって、血管内に適切に収めるために、配置中に移植
片を容易に回転することができる。In a preferred embodiment of the invention, the core wire 12
2 tapers from a diameter of 0.031 inches at the proximal end of the insertion catheter 110 to a diameter of 0.020 inches at the distal end of the insertion catheter. This feature ensures that the proximal end of the insertion catheter 110 is strong and the distal end of the insertion catheter is less prone to puncture or rupture of the blood vessel, but is not significantly deflected by the force of blood flow. In addition to providing anti-torsion and strength to the insertion catheter 110, the core wire 122 has greatly improved torsional stiffness, which allows rotation of the proximal end of the insertion catheter 110 about its longitudinal axis. , To a substantially equal rotation at the distal end of the insertion catheter. Thus, the implant can be easily rotated during placement to properly fit within the vessel.

【００５３】本発明によると、第二内部トラック126は
挿入カテーテル110の遠端部の周囲に配されている透明
なポリウレタン先端バルーン152と通じており、一方、
第三内部トラック128は先端バルーン152の近傍において
挿入カテーテル110の周囲に配されている透明なポリウ
レタン移植バルーン154と通じている。バルーン152と15
4とは、完全に膨張したときに、移植バルーン154が先端
バルーン152よりも長い形状でありつつ、外径または断
面輪郭が同じであるのが好ましい。バルーン152および1
54は、圧力に従って挙動し、流体注入手段142および150
をそれぞれ使用して膨張圧力を変化させることによっ
て、その断面輪郭を連続的かつ可逆的に変化させること
ができる。流体注入手段としては、その中身の容量を観
察しながら変化させることができる、スライド可能なピ
ストンを有する注入器を使用することができる。そし
て、そ注入器の中身の容量はバルーンの断面直径と関数
的相互関係を有しているのがよい。好適な膨張流体は濾
過した二酸化炭素であり、これはＸ線観察で容易に視覚
化することができる。In accordance with the present invention, the second inner track 126 communicates with a transparent polyurethane tip balloon 152 disposed around the distal end of the insertion catheter 110, while
The third inner track 128 communicates with a transparent polyurethane implanted balloon 154 disposed around the insertion catheter 110 near the distal balloon 152. Balloons 152 and 15
Preferably, when fully inflated, the implant balloon 154 has a longer shape than the distal balloon 152 and the same outer diameter or cross-sectional profile when fully inflated. Balloons 152 and 1
54 behaves according to the pressure and the fluid injection means 142 and 150
Can be used to change the inflation pressure continuously and reversibly. As the fluid injection means, an injector having a slidable piston that can be changed while observing the volume of the content can be used. The volume of the contents of the injector should be functionally correlated with the cross-sectional diameter of the balloon. A preferred inflation fluid is filtered carbon dioxide, which can be easily visualized by X-ray observation.

【００５４】挿入カテーテル110は、さらに、先端バル
ーン152に近接する先細の頭部156を有しており、直径８
FRの挿入カテーテルからより直径の大きい鞘導入器106
へと滑らかで外傷を与えることのない移行によって特長
付けられる堅い血管拡張器を与えている。先細の頭部15
6は、鞘導入器106の遠端部と係合して、鞘通路108内に
先細の頭部が引っ込んでしまうのを防ぐために配された
環状の合端唇158を形成してなるのが好ましい。挿入カ
テーテル110には、その周囲に、複数の放射線不透過性
のマーク（図示せず）をその長さに沿って等間隔で配す
ることによって、移植片の配置中に挿入カテーテルの位
置決めの助けとすることもできる。The insertion catheter 110 further has a tapered head 156 adjacent to the distal balloon 152 and has a diameter of 8 mm.
Larger sheath introducer 106 from FR insertion catheter
Providing a rigid vasodilator characterized by a smooth, non-traumatic transition to the vasodilator. Tapered head 15
6 forms an annular end lip 158 that is engaged with the distal end of the sheath introducer 106 to prevent the tapered head from retracting into the sheath passage 108. preferable. The insertion catheter 110 has a plurality of radiopaque marks (not shown) around its circumference that are equally spaced along its length to assist in positioning the insertion catheter during placement of the implant. It can also be.

【００５５】押し棒112は、可撓性と軸方向の圧縮強さ
とを併せ持つ金属製の圧縮バネであって、展開中に移植
片に対して力を及ぼす押し棒として作用する能力を失う
ことなく、曲がりくねった血管通路を辿ることができ
る。押し棒は、その内空間は挿入カテーテル110に関し
て、外空間は鞘導入器106に関して大きさが決められて
おり、鞘通路108の中をそれぞれと独立に動くことがで
きる。鞘通路108内で血流を止めるために、押し棒112の
遠端部にピストン162が設けられているのが好ましい。
押し棒の望ましくない後方への跳ね返りを低下させるた
めに、押し棒112はその遠端部の近くに、熱収縮ポリオ
レフィンまたはポリイミドの薄い被覆などの低下手段を
含むこともできる。The push rod 112 is a metal compression spring having both flexibility and axial compressive strength, without losing the ability to act as a push rod to exert a force on the implant during deployment. , Can follow tortuous vascular passages. The push rod is sized with its inner space relative to the insertion catheter 110 and its outer space with respect to the sheath introducer 106, and is capable of moving independently within the sheath passageway 108. Preferably, a piston 162 is provided at the distal end of the push rod 112 to stop blood flow within the sheath passage.
To reduce the unwanted back bounce of the push rod, push rod 112 may also include a reducing means near its distal end, such as a thin coating of heat shrink polyolefin or polyimide.

【００５６】図５ａおよび５ｂは、配置手段100の部品
として、押し棒112の代わりに使用される押し棒装置の
他の態様を示している。押し棒312は、押し棒本体317に
結合されており、配置手段100の近端部102に向かって配
されているハンドル313を有している。押し棒本体317は
螺旋コイル部320に結合されている。螺旋コイル部320の
遠端部には、鞘通路108内にステントの遠端部分を含む
ために、カップ322が配置されている。FIGS. 5 a and 5 b show another embodiment of a push rod device used in place of the push rod 112 as part of the positioning means 100. The push rod 312 is coupled to the push rod body 317 and has a handle 313 disposed toward the proximal end 102 of the placement means 100. The push rod body 317 is connected to the spiral coil section 320. At the distal end of the helical coil section 320, a cup 322 is disposed to include the distal end portion of the stent within the sheath passageway 108.

【００５７】ハンドル313は、ルーアー（luer）アダプ
ター314を有しており、これによって、テュオハイ−ボ
ースト（Tuohy Borst）コネクター（図示せず）と、挿
入カテーテル110を収容するためにハンドル313を通って
延びている管腔315と、押し棒本体317および押し棒堅化
部318を受けるメス接続部316とを接続している。The handle 313 has a luer adapter 314 that allows the Tuohy Borst connector (not shown) to pass through the handle 313 to accommodate the insertion catheter 110. The extending lumen 315 is connected to a female connection part 316 that receives the push rod body 317 and the push rod hardening part 318.

【００５８】押し棒本体317はハンドル313から末端方向
へ、即ち、離れる方向へ延びており、ポリエチレンなど
のポリマー材料でできている。押し棒本体317は、該本
体を通って延び、導入カテーテル110と押し棒堅化部318
とを受け入れる管腔319を有している。押し棒堅化部318
と押し棒本体317とはメス接続部316を介してハンドル31
3に結合されている。押し棒堅化部318は、移植片の配置
中に可撓性のある押し棒本体317をさらに支持する。ハ
ンドル313は、移植片の配置に際して、移植片を覆って
いる鞘が引かれている間、移植片を所定の場所に保持す
るのに使用される。The push rod body 317 extends distally, ie, away from the handle 313, and is made of a polymer material such as polyethylene. A push rod body 317 extends through the body and introduces catheter 110 and push rod stiffener 318.
And has a lumen 319 for receiving. Push rod hardening part 318
And the push rod body 317 are connected to the handle 31 via the female connection portion 316.
Combined with three. The push rod stiffener 318 further supports the flexible push rod body 317 during implant placement. The handle 313 is used to hold the implant in place during deployment of the implant while the sheath covering the implant is pulled.

【００５９】押し棒本体317の遠端部は螺旋コイル部320
に接続されている。螺旋コイル部320は、ステンレスス
チールなどの螺旋状に巻回された金属材料で作られてい
るのが望ましい。螺旋コイル部320は、螺旋コイル部320
と押し棒本体317との間の接合点で、螺旋コイル部320の
内側に螺合する内部バネ323を有している。この内部バ
ネ323は、比較的堅い押し棒本体317とより可撓的である
螺旋コイル部320との間で堅さの移行を行っている。内
部バネ323は、押し棒本体317から螺旋コイル部320へと
比較的滑らかで連続的に堅さを移行している。この態様
においては、より堅い押し棒本体からより可撓性に富ん
だコイルへと移行が起こっている。The distal end of the push rod body 317 is a spiral coil part 320
It is connected to the. The spiral coil section 320 is preferably made of a spirally wound metal material such as stainless steel. The spiral coil section 320 is a spiral coil section 320
An internal spring 323 that is screwed into the spiral coil portion 320 at a junction between the push rod body 317 and the push rod body 317. This internal spring 323 provides a stiffness transition between the relatively stiff push rod body 317 and the more flexible helical coil section 320. The inner spring 323 has a relatively smooth and continuous stiffness transition from the push rod body 317 to the spiral coil section 320. In this embodiment, a transition has taken place from a stiffer push rod body to a more flexible coil.

【００６０】螺旋コイル部320の末端には、螺旋コイル
部320を介して管腔321へとカップ322が螺合されてい
る。カップの開口部327は、鞘通路108内に収容されてい
る移植片の抹端部を受けるように配置されている。カッ
プ部322は、押し棒と移植片との堅さの不連続性故に発
生する鞘の捻れを最小化するように機能する。カップ部
322によって、配置中に、押し棒312と移植片とが１つの
部品であるかのように動くことが可能になる。本発明
は、この人工器官を保持ないし収容する他の手段も考慮
している。当該手段としては、押し棒と人工器官とが配
置中に１つの部品であるかのように挙動する、または鞘
の捻れが減少するように、人工器官を押し棒近傍の所定
位置に保持するいかなる構造も採用することができる。
このような構造の例としては、人工器官の内または外管
腔のいずれかと係合する爪、リボン、ワイヤおよび支柱
を挙げることができる。At the end of the spiral coil section 320, a cup 322 is screwed into the lumen 321 via the spiral coil section 320. The opening 327 in the cup is positioned to receive the distal end of an implant contained within the sheath passageway 108. The cup portion 322 functions to minimize sheath twisting caused by a discontinuity in stiffness between the push rod and the implant. Cup part
322 allows the push rod 312 and the implant to move as one piece during deployment. The invention contemplates other means for holding or containing the prosthesis. Such means may include any action that holds the prosthesis in place near the push rod so that the push rod and the prosthesis behave as a single part during deployment, or reduce sheath twist. Structures can also be employed.
Examples of such structures may include claws, ribbons, wires and struts that engage either the inner or outer lumen of the prosthesis.

【００６１】螺旋コイル部320、内部バネ323およびカッ
プ322は、それぞれ、それらを通り抜ける管腔321、32
5、および326を有している。管腔321、326、326、315、
および319は、挿入カテーテル110を受け入れる連続開口
部を形成している。The helical coil section 320, the internal spring 323 and the cup 322 respectively have lumens 321 and 32 passing therethrough.
5, and 326. Lumens 321, 326, 326, 315,
And 319 form a continuous opening for receiving the insertion catheter 110.

【００６２】図７ａおよび７ｂは、移植片の位置または
大きさが不適切であったために予期しなかった漏出が観
察された場合に、配置された移植片を折り畳んで該移植
片を鞘導入器106に再搭載する、配置手段100の一部とし
て提供される任意採用の巻き取り装置170を示してい
る。巻き取り装置170は、搭載アーム172によって、鞘導
入器106の近端部に隣接させて配され、その巻き取りシ
リンダー176の周囲に巻回された複数の縫合糸の輪を含
む。この縫合糸の輪は、押し棒112の中央軸通路を通っ
て延びるように配され、図７ｂに示されているように、
移植片の抹消側バネ部における各山の周りに渡されてい
る。巻き取り装置170の巻き取りシリンダー176を回転さ
せ、固定するＬ字型ハンドル178と放出可能な歯止め
（図示せず）が備えられている。巻き取り装置の本体に
は、各縫合糸の輪174を選択的かつ同時に一点で切断し
て縫合糸を除去するための刃180が取り付けられてい
る。任意に巻き取り装置170が採用された場合には、押
し棒112の遠端部のピストン162を使用せずに、縫合糸の
輪174によって移植片の抹消側バネ部を接続するように
しなくてはならない。FIGS. 7a and 7b show that when an unexpected leak is observed due to improper location or size of the implant, the deployed implant can be folded and the implant introduced into the sheath introducer. Shown is an optional take-up device 170 provided as part of the positioning means 100 for reloading at 106. The winding device 170 includes a plurality of loops of suture wound by a mounting arm 172 adjacent to the proximal end of the sheath introducer 106 and wound around a winding cylinder 176 thereof. This loop of suture is arranged to extend through the central shaft passage of the push rod 112 and, as shown in FIG.
It is passed around each peak in the peripheral spring portion of the implant. An L-shaped handle 178 for rotating and fixing the take-up cylinder 176 of the take-up device 170 and a releasable pawl (not shown) are provided. A blade 180 for selectively and simultaneously cutting the suture loop 174 at one point to remove the suture is attached to the main body of the winding device. If the winding device 170 is optionally employed, the peripheral side spring portion of the implant may not be connected by a loop of suture 174 without using the piston 162 at the distal end of the push rod 112. Not be.

【００６３】図８は、血管中で配置手段100を操作して
いる間に流れ出した血栓を捕獲するための、本発明の配
置手段100に使用することのできる微細栓子フィルター
管182を示している。フィルター管182は鞘導入器106上
をスライドするように適合され、腎フィルター184と腸
骨フィルター186とを有している。フィルター184および
186は類似の構造をしており、フィルター管182の周囲に
間隔をあけて配された軸方向に延びる一連のスリットに
よって形成される、可撓性のある複数のスポーク188を
有する。スポーク188の底部あたりにはナイロンメッシ
ュの織物190が添付されている。フィルター管182がその
近端部を押されて軸方向に圧縮されており、その遠端部
が先端バルーン152によって所定の位置に保持されてい
るとき、スポーク188は放射状に外向きに撓んで、メッ
シュの織物190でスポーク188の上部の隙間から入ってく
る血栓を捕獲するボール状のフィルターを形成する。フ
ィルター管の遠端部が固定されている間に、フィルター
管182の近端部を引いてフィルター184および186を折り
畳み、患者からフィルター管182を除去する準備をする
ことができる。FIG. 8 shows a micro obturator filter tube 182 that can be used in the placement means 100 of the present invention to capture thrombus that has flowed out while operating the placement means 100 in a blood vessel. I have. The filter tube 182 is adapted to slide over the sheath introducer 106 and has a renal filter 184 and an iliac filter 186. Filter 184 and
186 is similar in construction and has a plurality of flexible spokes 188 formed by a series of axially extending slits spaced around a filter tube 182. Around the bottom of the spoke 188, a nylon mesh fabric 190 is attached. When the filter tube 182 is pressed in its proximal end and compressed axially, and its distal end is held in place by the distal balloon 152, the spokes 188 flex radially outwardly, The mesh fabric 190 forms a ball-shaped filter that captures thrombi that enter through the gaps above the spokes 188. While the distal end of the filter tube is fixed, the proximal end of the filter tube 182 can be pulled to collapse the filters 184 and 186, preparing to remove the filter tube 182 from the patient.

【００６４】ここで、単一肢移植片20を外科的に配置す
る方法を説明する図９ａ〜９ｄを参照する。血管と動脈
瘤18との必要な位置測定はすでになされたものとし、適
切な大きさの移植片が選択され、適切な大きさの配置手
段100における鞘通路108の遠端部内に搭載されているも
のとする。さらに、高解像度の蛍光透視手段を有する自
由に位置決めすることのできるＣアーム、高品質の血管
造影手段、およびデジタル減算血管写機能を含む、モニ
ターおよび視覚化目的のために使用される所定の設備が
この分野に精通している外科医によって使用可能な状態
にあるとする。Reference is now made to FIGS. 9a-9d, which illustrate a method of surgically placing a single limb implant 20. The necessary positioning of the vessel and the aneurysm 18 has already been performed, and an appropriately sized graft is selected and mounted within the distal end of the sheath passage 108 in the appropriately sized deployment means 100. Shall be. In addition, certain equipment used for monitoring and visualization purposes, including freely positionable C-arms with high resolution fluoroscopy means, high quality angiography means, and digital subtraction angiography functions Is available for use by surgeons familiar with this field.

【００６５】第一段階として、高流速ピッグテイル血管
写カテーテル（high flow pig tailangiography cathet
er）（図示せず）を大動脈−腎動脈結合部16上方の大動
脈における経皮導入口を介して配し、血管写することに
よって、左右いずれかの最も大きな大腿動脈を決定す
る。このピッグテイルカテーテルはこのままにしてお
く。好ましくは、その遠端部に先端バルーン（図示せ
ず）を有する可撓性のある案内ワイヤ200を、より大き
な大腿動脈の経皮導入口を介して血管中に導入し、その
先端バルーンが大動脈−腎動脈結合部16の上方に来るま
で少しずつ上方に進める。次に、サイドポート手段116
を介してヘパリン化溶液を予め充填した配置手段100を
大腿部の入口を介して導入し、案内ワイヤの近端部を第
一端部ポート手段130を介して第一内部トラック124に挿
入することによって、配置手段100に案内ワイヤを辿ら
せ、動脈瘤18の位置までゆっくりと進ませる。案内ワイ
ヤ200に沿って配置手段100を進めている間、先端バルー
ン152を二酸化炭素で少し膨張させて、該バルーンをよ
りはっきりと視覚化すると共に、傷を付けずに血管を拡
張すると都合がよい。腎動脈12および14の位置を確認す
るために、第一端部ポート手段130から腎動脈の上方に
ある第一内部トラック124の遠端開口部へと、差異のは
っきりした媒体を注入する。この時点で、配置手段100
は、中央部側バネ部34が腎動脈12および14の位置、また
は直下にあり、抹消側バネ部36が分岐した大動脈−腸骨
結合部の上方にあって、動脈瘤18の中にないように配置
されているはずである。この領域を通る血流は、流体注
入手段142を用いて先端バルーン152をより完全に膨張さ
せることによって、図９ａに示されているように、大動
脈10を塞ぐようにして遮断することができる。大動脈血
流を遮断しておいて、鞘導入器106および該導入器によ
って運ばれた、圧縮されている移植片20が患者の大動脈
の曲がりに最もよく適合して配列されるように、配置手
段100を回転する。As a first step, a high flow pig tailangiography cathet
er) (not shown) via the percutaneous entry in the aorta above the aortic-renal artery junction 16 and angiography to determine the left or right largest femoral artery. The pigtail catheter is left as is. Preferably, a flexible guidewire 200 having a distal balloon (not shown) at its distal end is introduced into the blood vessel through the percutaneous entry of the larger femoral artery, where the distal balloon is -Advance little by little until it is above the renal artery junction 16. Next, the side port means 116
The placement means 100, pre-filled with the heparinized solution, is introduced via the thigh inlet and the proximal end of the guidewire is inserted into the first inner track 124 via the first end port means 130 This causes the positioning means 100 to follow the guide wire and slowly advance to the position of the aneurysm 18. While advancing the deployment means 100 along the guidewire 200, it is convenient to slightly inflate the distal balloon 152 with carbon dioxide to more clearly visualize the balloon and dilate the vessel without trauma. . In order to locate the renal arteries 12 and 14, a well-defined medium is injected from the first end port means 130 into the distal opening of the first internal track 124 above the renal artery. At this point, the placement means 100
Is such that the central spring portion 34 is at or just below the renal arteries 12 and 14 and the peripheral spring portion 36 is above the bifurcated aortic-iliac junction and not in the aneurysm 18. Should be located at Blood flow through this region can be blocked by blocking the aorta 10, as shown in FIG. 9a, by more fully inflating the distal balloon 152 using the fluid injection means 142. With the aortic blood flow blocked, the positioning means is such that the sheath introducer 106 and the compressed implant 20 carried by the introducer are best adapted to the curvature of the patient's aorta. Rotate 100.

【００６６】バネ押し棒112を動かさないようにしつ
つ、鞘導入器106を小距離、約3.5 cmだけ引くことによ
って中央部側バネ部34の配置が開始される。中央部側バ
ネ部が鞘通路108から放出されるのに従い、図９ｂに示
されているように、中央部側バネ部34の指状部46は広が
って出てくる。次に、挿入カテーテル110を上方に進め
て、移植バルーン154を配置したばかりの中央部側バネ
部34内に位置させる。そして、第一端部ポート手段から
さらに差異のはっきりした媒体を注入することによっ
て、腎動脈12および14に関する中央部側バネ部の位置と
配列とを確認する。適切な確認が行われたら、移植バル
ーン154を比較的高い圧力がかかるように膨張させて中
央部側バネ部34に対して滑らかな血管壁の台座を作り、
図９ｃに示されているように、バネ部に弾力的ではない
変形を生じることなく、バネ部を大動脈10の内表面に一
致固定させる。The arrangement of the center side spring portion 34 is started by pulling the sheath introducer 106 a small distance, about 3.5 cm, while keeping the spring push bar 112 stationary. As the central spring is released from the sheath passage 108, the fingers 46 of the central spring 34 expand as shown in FIG. 9b. Next, the insertion catheter 110 is advanced upward to be positioned in the center side spring portion 34 where the transplant balloon 154 has just been placed. The position and arrangement of the central spring portion with respect to the renal arteries 12 and 14 are then confirmed by injecting a more distinct medium from the first end port means. After proper confirmation, the implantation balloon 154 is inflated to apply relatively high pressure to create a smooth pedestal of the blood vessel wall with respect to the central side spring portion 34,
As shown in FIG. 9c, the spring portion is fitted and fixed to the inner surface of the aorta 10 without causing inelastic deformation of the spring portion.

【００６７】膨張させた移植バルーン154で中央部側バ
ネ部34を固定しておいて、鞘導入器106を、鞘通路108内
から抹消側バネ部36が放出される地点の少し手前の位置
まで、引く。抹消側バネ部36が同側腸骨血管11も対側腸
骨血管13も塞がないであろうことを確認したら、図９ｄ
に示されているように、鞘通路108内から末梢側バネ部3
6が放出されるのに充分な距離、鞘導入器を引くことが
できる。With the central spring portion 34 fixed by the inflated transplant balloon 154, the sheath introducer 106 is moved from the inside of the sheath passage 108 to a position slightly before the point where the peripheral spring portion 36 is discharged. ,Pull. Once the peripheral side spring portion 36 has confirmed that neither the ipsilateral iliac vessel 11 nor the contralateral iliac vessel 13 will be blocked, FIG.
As shown in FIG.
The sheath introducer can be pulled a sufficient distance for 6 to be released.

【００６８】それから、移植バルーン154を少しずつゆ
っくりと縮小することによって、新しく配置された移植
片20に血流を静かに導入することができる。移植バルー
ン154を約２cmの幅で繰り返し縮小させ、移植片20を通
過すべく下方に移動させ、移植材24の皺を伸ばすために
再膨張してもよい。移植バルーン154が移植片20を通過
して下方に移動し、末梢側バネ部36内に入ってきたら、
移植バルーン154を比較的高い圧力で再び膨張させて末
梢側バネ部を血管の内表面に一致固定させるようにする
ことができる。理解されるように、中央部29を取り囲ん
でいる拡張性の泡沫スリーブ58（図１にのみ示されてい
る）は、動脈瘤18の周囲の凝血を促進するように作用す
る。The blood flow can then be gently introduced into the newly placed graft 20 by slowly shrinking the graft balloon 154 little by little. Implant balloon 154 may be repeatedly contracted to a width of about 2 cm, moved down past implant 20, and re-inflated to smooth the wrinkles of implant 24. When the transplant balloon 154 moves downward through the graft 20 and enters the peripheral side spring portion 36,
The implantation balloon 154 can be inflated again at a relatively high pressure so that the distal spring portion conforms to the inner surface of the blood vessel. As will be appreciated, an expandable foam sleeve 58 (shown only in FIG. 1) surrounding the central portion 29 serves to promote clotting around the aneurysm 18.

【００６９】移植片20が不適切に配置されていることが
観察され、任意採用の巻き取り装置170がある場合は、
図７ａに示されているように、そのＬ字型ハンドル178
を反時計方向に非常にゆっくりと回転させ、移植片20の
抹消側バネ部36を折り畳んで鞘通路108内に再搭載する
ことができる。移植片20の再搭載中に鞘を上方に押し上
げて、先細の頭部156の環状合端唇158と鞘導入器106の
遠端部との間の合端シールを再確立することもできる。
好ましくは、視覚確認のために二酸化炭素などの差異の
はっきりした媒体で先端バルーン152を少し膨張させた
後に、配置手段100を静かに引く。この除去過程で血管
の破裂や塞栓化が起こらなかったことを、先に配置した
ピッグテイルカテーテルを介した血管写によって行うと
よい。If it is observed that the implant 20 is improperly placed and there is an optional winding device 170,
As shown in FIG. 7a, the L-shaped handle 178
Can be rotated very slowly in a counterclockwise direction so that the peripheral spring portion 36 of the implant 20 can be folded and reloaded into the sheath passageway 108. The sheath may be pushed up during reloading of the implant 20 to re-establish the end-to-end seal between the annular end lip 158 of the tapered head 156 and the distal end of the sheath introducer 106.
Preferably, the deployment means 100 is gently pulled after slightly inflating the distal balloon 152 with a well-defined medium such as carbon dioxide for visual confirmation. The fact that no rupture or embolization of the blood vessel has occurred during this removal process may be performed by angiography through the previously arranged pigtail catheter.

【００７０】移植片20が正しく配置されたら、配置手段
100と案内ワイヤ200とを患者から完全に引き出すことが
でき、通常の方法で導入口を処置することができる。任
意採用の巻き取り装置170が使用された場合は、縫合糸
輪174を刃180で切断して、Ｌ字型ハンドル178を反時計
方向に回転することによって除去することができる。次
いで、大腿動脈を介して移植片20に光学ファイバーカテ
ーテル（図示せず）を挿入して光分解可能な小包56（図
１のみに示されている）に光を照射することによって、
小包から組織接着剤を放出することができる。これによ
って、移植片を血管に接着させるのを補助し、漏洩の元
になる微小隙間をシールすることができる。心臓に最も
近い中央部側バネ部34での漏洩の発生に特に注意しなが
ら、術後ＣＡＴスキャンおよび超音波撮影を行って動脈
瘤が隔絶されたことを確認することもできる。Once the implant 20 is correctly positioned, the positioning means
100 and guidewire 200 can be completely withdrawn from the patient and the inlet can be treated in the usual manner. If the optional winding device 170 is used, the suture loop 174 can be cut with a blade 180 and removed by rotating the L-shaped handle 178 counterclockwise. A fiber optic catheter (not shown) is then inserted into the graft 20 via the femoral artery to illuminate the photodegradable parcel 56 (shown only in FIG. 1),
The tissue adhesive can be released from the parcel. This can assist in adhering the graft to the blood vessel and seal the small gaps that can cause leakage. A postoperative CAT scan and ultrasound imaging can also be performed to confirm that the aneurysm has been isolated, paying particular attention to the occurrence of leakage at the central spring portion 34 closest to the heart.

【００７１】ここで、図１０ａおよび１０ｂを参照す
る。本発明による分岐移植片60を配置する単一導入口法
は、手続き的には、単一肢移植片20に関して先に記載し
た方法に類似している。しかしながら、通常の案内ワイ
ヤ200の代わりに使用され、その遠端部に制御可能なバ
ルーン208を有している先端変向案内ワイヤ206の助けを
借りて、対側腸骨血管13内に対側肢66を配置する追加手
続きが必要である。分岐移植片60は、鞘導入器106が移
植片接続部63を通り過ぎて引かれるにつれ、中央部側バ
ネ部68Aの配置に続いて、図１０ａに示されているよう
に、対側肢66が、概ね、動脈瘤18の位置か対側腸骨血管
13の入口部に広がるように、対側肢66を主肢62の横側に
折り畳んで鞘通路108に搭載しておく。保持環79が抹消
側バネ部72Bの早すぎる拡張を防ぎ、これによって、抹
消側バネ部72Bを対側腸骨血管中で動かして、適切な配
置個所に位置させるのが可能になる。Reference is now made to FIGS. 10a and 10b. The single inlet method of placing a bifurcated graft 60 according to the present invention is procedurally similar to the method described above with respect to the single limb graft 20. However, contralateral into the contralateral iliac vessel 13 with the help of a tip-deflecting guidewire 206 which is used in place of the normal guidewire 200 and has a controllable balloon 208 at its distal end Additional procedures are needed to place limb 66. The bifurcated graft 60 may be placed in the contralateral limb 66 as shown in FIG. 10a following the placement of the central spring 68A as the sheath introducer 106 is pulled past the graft connection 63. , Generally, the location of the aneurysm 18 or contralateral iliac vessels
The contralateral limb 66 is folded to the side of the main limb 62 and mounted on the sheath passage 108 so as to spread over the 13 entrances. Retaining ring 79 prevents premature expansion of peripheral spring portion 72B, thereby allowing peripheral spring portion 72B to be moved in the contralateral iliac blood vessel and positioned at the appropriate location.

【００７２】抹消側バネ部72Bを配置するために、移植
バルーン154を縮小させ、挿入カテーテル110を挿入され
ている変向案内ワイヤ206と共に移植片接続部63まで引
く。変向案内ワイヤ206の遠端部を変向させて移植片60
の対側肢66内へと向けるために、ダイヤル制御（図示せ
ず）を使用することができる。次いで、変向案内ワイヤ
206を対側腸骨血管13内に深く進入させて、先端バルー
ン208を十分に膨張させて変向案内ワイヤを血管内に固
定することができる。それ自身の先端バルーン152を少
し膨張させて、挿入カテーテル110を固定された変向案
内ワイヤ206に沿って、中央部側バネ部72Aと末梢側バネ
部72Bとの間の対側肢66へと進入させる。その後、挿入
カテーテルの先端バルーンをもう少し大きく膨張させ
て、血流によって対側肢の移植材24が対側腸骨血管13の
下方へと運ばれるようにする。挿入カテーテルの先端バ
ルーン152を縮小させて保持環79によって押さえられて
いる末梢側バネ部72B内に進め、保持環79を破壊するこ
となく摩擦力によって末梢側バネ部72Bを保持するため
に先端バルーン152を注意深く少し膨張させ、対側肢66
の末梢側端部が所望の位置にくるまで挿入カテーテル11
0をさらに対側腸骨血管13内に進ませることによって、
対側肢66を最終的に所望の位置に移動させる。そして、
図１０ｂに示されているように、保持環79を拡張ないし
破壊して末梢側バネ部72Bを放出するのに十分な圧力
で、最終的に、先端バルーンを再膨張させる。配置手段
100を引いて患者から除去し、通常の方法で導入口を処
置する。In order to dispose the peripheral side spring portion 72B, the implantation balloon 154 is contracted, and the insertion catheter 110 is pulled together with the inserted deflection guide wire 206 to the graft connection portion 63. The distal end of the deflecting guidewire 206 is diverted to implant 60
A dial control (not shown) can be used to point into the contralateral limb 66 of the vehicle. Then, the turning guide wire
Having the 206 penetrate deep into the contralateral iliac vessel 13, the distal balloon 208 can be fully inflated to secure the diverting guidewire within the vessel. By slightly inflating its own distal balloon 152, the insertion catheter 110 is moved along the fixed deflection guide wire 206 to the contralateral limb 66 between the central spring portion 72A and the distal spring portion 72B. Let me enter. Thereafter, the distal balloon of the insertion catheter is inflated a little more so that the blood flow carries the contralateral limb implant 24 below the contralateral iliac vessel 13. The distal balloon 152 of the insertion catheter is reduced and advanced into the peripheral spring portion 72B held by the retaining ring 79, and the distal balloon is retained to hold the peripheral spring portion 72B by frictional force without breaking the retaining ring 79. Carefully inflate 152 slightly, contralateral limb 66
Until the distal end of the catheter is at the desired position.
By moving 0 further into the contralateral iliac vessels 13,
The contralateral limb 66 is finally moved to a desired position. And
As shown in FIG. 10b, the distal balloon is finally reinflated with sufficient pressure to expand or break the retaining ring 79 and release the distal spring portion 72B. Arrangement means
Remove 100 from the patient by subtracting 100 and treat the inlet in the usual manner.

【００７３】本発明による対側肢66に延長移植片80を同
軸的に結合する方法は、単一肢移植片20に関して先に記
載した方法にやはり似ている。この方法は延長移植片80
を対側肢66に結合するためのものであるが、同側肢64に
延長移植片80を配置する場合も同様の方法で行うことを
理解されたい。The method of coaxially connecting the extension graft 80 to the contralateral limb 66 according to the present invention is also similar to the method described above for the single limb graft 20. This method uses extension graft 80
To the contralateral limb 66, but it should be understood that placement of the extension graft 80 on the ipsilateral limb 64 is accomplished in a similar manner.

【００７４】図１１を参照すると、経皮導入口を介して
対側の大腿動脈を通じて延長移植片80は配置される。制
御可能先端バルーン202を有する案内ワイヤ200を、対側
肢66を通して上方へ送り、先に配置した分岐移植片60の
主肢62中に進める。そして、予め延長移植片80を搭載し
た配置手段100を、やはり第一内部トラック124を用いて
案内ワイヤ200に沿って送り、延長移植片80の結合部82
が一部対側肢66の内側に入る位置、好ましくは、結合部
82の第一バネ部88Aが分岐移植片60の末梢側バネ部72Bと
重なる位置にまで進める。押し棒112を動かさずに保持
しながら、鞘導入器106を引いて第一バネ部88Aを放出す
る。第一バネ部88Aを対側肢66の内表面と一致結合させ
るために、挿入カテーテル110を上方に進めて第一バネ
部88A中に移植バルーン154を位置させ、移植バルーンを
比較的高い圧力で膨張させる。先に記載したように、結
合された移植片肢から漏洩していないことを確認するた
めに、差異のはっきりした媒体を注入することもでき
る。Referring to FIG. 11, an extension graft 80 is placed through the contralateral femoral artery via the percutaneous port. A guidewire 200 having a controllable tip balloon 202 is advanced upward through the contralateral limb 66 and advanced into the main limb 62 of the previously placed bifurcated graft 60. Then, the positioning means 100 previously loaded with the extension graft 80 is fed along the guide wire 200 also using the first inner track 124, and the connecting portion 82 of the extension graft 80 is
Is located inside the part of the contralateral limb 66, preferably the joint
The first spring portion 88A of 82 is advanced to a position where the first spring portion 88A overlaps with the peripheral side spring portion 72B of the branch graft 60. While holding the push rod 112 without moving, the sheath introducer 106 is pulled to release the first spring portion 88A. In order to bring the first spring portion 88A into conformal engagement with the inner surface of the contralateral limb 66, advance the insertion catheter 110 to position the implantation balloon 154 in the first spring portion 88A, and place the implantation balloon at a relatively high pressure. Inflate. As noted above, a well-differentiated medium can be injected to ensure that no leaks have occurred from the combined graft limb.

【００７５】次に、鞘通路108から第二バネ部88Bおよび
第三バネ部90がうまく放出されるまで鞘導入器106をさ
らに引く。この第三バネ部90は保持環91のために圧縮さ
れた状態になっている。そして、移植バルーン154を縮
小させ、下方に動かして第三バネ部90内に入れる。移植
バルーン154を少し再膨張させて摩擦力によって第三バ
ネ部を保持させる。このときに、移植バルーン154を膨
張させ過ぎて保持環91を拡張したり破壊したりしないよ
うに注意する。挿入カテーテル110をさらに引くことに
よって、長さ調節部84の末端側端部が、概ね、腸骨分岐
下部または下腹部分岐のほぼ直上に配置されることにな
る。図１１に示されているように、周囲にある保持環91
を拡張ないし破壊し、第三バネ部90を対側腸骨血管13の
内表面に一致固定させるのに十分な程度の比較的高圧で
移植バルーン154を膨張させる。このようにして、第三
バネ部90は配置される。本願明細書中で先に説明したよ
うに、移植バルーン154を使用して延長移植片80の皺な
どを除去することができる。血管写などによって、漏洩
のないことが最終的に確認されると、配置手段100を患
者から引き出して導入口を処置することができる。Next, the sheath introducer 106 is further pulled until the second spring portion 88B and the third spring portion 90 are successfully released from the sheath passage 108. The third spring portion 90 is in a compressed state for the holding ring 91. Then, the transplant balloon 154 is contracted and moved downward to enter the third spring portion 90. The transplant balloon 154 is slightly inflated again to hold the third spring portion by frictional force. At this time, care should be taken not to expand or break the retaining ring 91 by inflating the implantation balloon 154 too much. Further pulling of the insertion catheter 110 will cause the distal end of the length adjuster 84 to be positioned generally just below the iliac bifurcation or the lower abdominal bifurcation. As shown in FIG. 11, the surrounding retaining ring 91
Is expanded or destroyed, and the implantation balloon 154 is inflated at a relatively high pressure sufficient to cause the third spring portion 90 to conform and fix to the inner surface of the contralateral iliac blood vessel 13. Thus, the third spring portion 90 is arranged. As previously described herein, the implant balloon 154 can be used to remove wrinkles and the like of the extension implant 80. When it is finally confirmed that there is no leakage by angiography or the like, the placement means 100 can be pulled out of the patient and the inlet can be treated.

【００７６】本発明の移送システム、特に、可撓性があ
り圧縮可能な押し棒に関しては、所定内腔位置に移送す
るカテーテルの柱身内に保持されるのであれば、他の内
腔器官を配置するのにも使用可能であると考えられる。
内腔器官という用語は、体内腔内への一時的または永久
的移植に使用される医療装置を意味することを意図し、
該体内腔は自然にできた内腔または人工的に作られた内
腔を含む。内腔器官を移植することのできる内腔の例と
しては、冠状、腸間膜, 末梢または大脳脈血管系内にあ
る動脈、静脈、胃腸管、胆汁管、尿道、気管、肝側路、
卵管などを挙げることができるが、制限はない。様々な
型の内腔器官も開発されてきているが、各々が対象とな
る管腔壁の力学を修正する独特の有益な構造を提供して
いる。With respect to the delivery system of the present invention, and in particular with respect to the flexible and compressible push rod, other luminal organs can be placed if they are retained within the body of a catheter to be delivered to a given lumen location. It could be used to do so.
The term luminal organ is intended to mean a medical device used for temporary or permanent implantation into a body lumen,
The body lumen includes a naturally-occurring lumen or an artificially created lumen. Examples of lumens into which luminal organs can be implanted include arteries, veins, gastrointestinal tract, bile ducts, urethra, trachea, hepatic tract, coronary, mesenteric, peripheral or cerebral vasculature.
An oviduct can be mentioned, but there is no limitation. Various types of luminal organs have also been developed, each providing a unique beneficial structure that modifies the dynamics of the lumen wall of interest.

【図面の簡単な説明】[Brief description of the drawings]

【図１】図１は、動脈瘤を治療するために患者の大動脈
内に完全に配置された本発明の単一肢移植片を示す正面
図である。FIG. 1 is a front view showing a single limb implant of the present invention completely positioned within a patient's aorta to treat an aneurysm.

【図２】図２は、図１に類似するが、移植片の腎動脈上
部固定のために移植片に取り付けられた任意使用の固定
バネを示している。FIG. 2 is similar to FIG. 1, but shows an optional fixation spring attached to the graft for fixation of the graft above the renal artery.

【図３】図３は、大動脈とそれに結合する側方腸骨血管
内に完全に配置された本発明の分岐移植片を示す立面図
である。FIG. 3 is an elevational view showing a bifurcated graft of the present invention completely positioned within the aorta and the associated lateral iliac vessels.

【図４】図４は、図３に類似するが、分岐移植片の側方
肢に結合する本発明の延長移植片を示している。FIG. 4 is similar to FIG. 3, but shows an extension graft of the present invention attached to the lateral limb of a bifurcated graft.

【図５】図５は、本発明の移植片配置手段を示す斜視図
である。FIG. 5 is a perspective view showing an implant placement means of the present invention.

【図５A】図５Aは、本発明の押し棒の代わりとなる態様
を示す立面図である。FIG. 5A is an elevation view showing an alternative embodiment of the push rod of the present invention.

【図５B】図５Bは、図５Aの押し棒の分解立面図であ
る。FIG. 5B is an exploded elevation view of the push rod of FIG. 5A.

【図６】図６は、図５の６−６線におおよそ沿った断面
図である。FIG. 6 is a cross-sectional view taken generally along the line 6-6 in FIG. 5;

【図７】図７ａは、本発明の巻き取り装置を示す斜視図
である。図７ｂは、図７ａにおいて円で囲まれている部
分の部分拡大図であって、巻き取り装置の縫合糸輪の配
置を示している。FIG. 7a is a perspective view showing a winding device of the present invention. FIG. 7b is a partially enlarged view of a portion surrounded by a circle in FIG. 7a, and shows an arrangement of a suture loop of the winding device.

【図８】図８は、機能している状態にある本発明の微栓
子フィルター管の立面図である。FIG. 8 is an elevational view of the microobturator filter tube of the present invention in a functioning state.

【図９a】FIG. 9a

【図９b】FIG. 9b

【図９c】FIG. 9c

【図９d】図９a〜９dは、本発明の単一肢移植片の配置
方法を説明する一連の立面図である。9a to 9d are a series of elevational views illustrating the method of placing a single limb implant of the present invention.

【図１０a】FIG. 10a

【図１０b】図１０ａ及び１０ｂは、本発明の分岐移植
片の配置方法を説明する立面図である。10a and 10b are elevation views illustrating a method for placing a bifurcated graft of the present invention.

【図１１】図１１は、本発明の、分岐移植片の側方肢と
結合する延長移植片の配置方法を説明する立面図であ
る。FIG. 11 is an elevational view illustrating the method of the present invention for deploying an extension graft for connection to the lateral limb of a bifurcated graft.

フロントページの続き (72)発明者 ロステテール， ティモシー ウェイド アメリカ合衆国，フロリダ州 33328，ク ーパー シティー，９ス アベニュー エ ス．ダブリュー．5251 (72)発明者 グレナン，トレバー アメリカ合衆国，フロリダ州 33133，マ イアミ，ベイビュー ロード 3617Continuing the front page (72) Inventor Lostaire, Timothy Wade, United States, 33328, Florida, Cooper City, 9th Avenue ES. Wu. 5251 (72) Inventor Grennan, Trevor Bayview Road 3617, Miami 33133, Florida, United States 3617

Claims (15)

【特許請求の範囲】[Claims] 【請求項１】 内腔人工器官を配置する装置であって、
近端部、該近端部の反対位置にある遠端部、および該遠
端部に開口すると共に軸方向に延び、前記内腔人工器官
を収容する大きさの鞘通路を有する、長い鞘導入器、並
びに前記鞘導入器とは独立に動き、前記鞘通路内に滑動
可能に収容される長い押し棒であって、近端部分と該近
端部分から離れた位置にある遠端部分とを有し、前記鞘
導入器と前記押し棒との間の相互滑動によって前記鞘通
路の開口部から前記内腔人工器官を配置することができ
るように、前記押し棒の該遠端部分が前記内腔人工器官
に近接して位置することができるようになっている押し
棒を含み、前記押し棒の前記遠端部分が押し棒の近端部
分とは異なる可撓性を有していることを特徴とするこ
と。1. An apparatus for placing a luminal prosthesis, comprising:
A long sheath introduction having a proximal end, a distal end opposite the proximal end, and a sheath passage opening at the distal end and extending axially and sized to receive the endoluminal prosthesis; A long push rod which moves independently of the sheath introducer and is slidably received within the sheath passageway, comprising a proximal end portion and a distal end portion remote from the proximal end portion. The distal end portion of the push rod is positioned such that the distal end portion of the push rod can be positioned from the opening of the sheath passage by mutual sliding between the sheath introducer and the push rod. A push rod adapted to be located proximate to the prosthetic prosthesis, wherein the distal end portion of the push rod has a different flexibility than the proximal end portion of the push rod. Be a feature. 【請求項２】 前記遠端部分の可撓性が前記近端部分の
可撓性よりも大きいことを特徴とする請求項１に記載の
装置。2. The apparatus of claim 1, wherein the distal end has a greater flexibility than the proximal end. 【請求項３】 前記押し棒の遠端部分が可撓性のある螺
旋コイル部材を有していることを特徴とする請求項１に
記載の装置。3. The apparatus of claim 1, wherein the distal end portion of the push rod comprises a flexible helical coil member. 【請求項４】 前記押し棒の前記遠端部分であって前記
鞘通路に近接する位置に配されており、配置に先立って
前記内腔人工器官をその内部に入れる包含手段をさらに
有している、請求項３に記載の装置。4. The push rod further includes a containment means disposed at the distal end portion of the push rod and proximate to the sheath passageway for receiving the luminal prosthesis therein prior to deployment. The device of claim 3, wherein 【請求項５】 前記押し棒がそれ自身に沿って変化する
可撓性を有する部分を有し、該押し棒が、前記遠端部分
に向かって比較的可撓性が大きく、前記近端部分に向か
って比較的可撓性が小さくなっていることを特徴とす
る、請求項１に記載の装置。5. The push rod has a flexible portion that varies along itself, wherein the push rod is relatively flexible toward the distal end portion and the push end portion is flexible. Device according to claim 1, characterized in that it is relatively less flexible towards. 【請求項６】 前記押し棒の可撓性を有する部分が、前
記近端部分と前記遠端部分との間に中間可撓域を有し、
該中間可撓域が前記近端部分と前記遠端部分との間で比
較的なめらかに可撓性を変化させることを特徴とする、
請求項５に記載の装置。6. The flexible portion of the push rod has an intermediate flexible zone between the proximal end portion and the distal end portion,
Wherein the intermediate flexible region changes the flexibility relatively smoothly between the near end portion and the far end portion,
An apparatus according to claim 5. 【請求項７】 前記押し棒の前記遠端部分であって前記
鞘通路に近接する位置に配されており、配置に先立って
前記内腔人工器官をその内部に入れる包含手段をさらに
有している、請求項１に記載の装置。7. The push rod further includes inclusion means disposed at the distal end portion of the push rod proximate to the sheath passageway and for receiving the luminal prosthesis therein prior to deployment. The apparatus of claim 1, wherein 【請求項８】 内腔人工器官を配置する装置であって、
近端部、該近端部の反対位置にある遠端部、および該遠
端部に開口すると共に軸方向に延び、前記内腔人工器官
を収容して放射状に圧縮された状態で維持する大きさの
鞘通路を有する、長い鞘導入器、並びに前記鞘導入器と
は独立に動き、前記鞘通路内に滑動可能に収容される長
く、可撓性があり長さ方向に圧縮可能な押し棒であっ
て、近端部分と該近端部分から離れた位置にある遠端部
分とを有し、前記鞘導入器と前記押し棒との間の相互滑
動によって前記鞘通路の開口部から前記内腔人工器官を
配置することができるように、前記押し棒の該遠端部分
が前記内腔人工器官に近接して位置することができるよ
うになっている押し棒を含むことを特徴とすること。8. An apparatus for placing a luminal prosthesis, comprising:
A proximal end, a distal end opposite the proximal end, and a size opening at the distal end and extending axially to receive and maintain the endoluminal prosthesis in a radially compressed state; A long sheath introducer having a sheath passageway, and a long, flexible, longitudinally compressible push rod that moves independently of the sheath introducer and is slidably received within the sheath passageway. Having a proximal end portion and a distal end portion remote from the proximal end portion, wherein the inner slide from the opening of the sheath passage by mutual sliding between the sheath introducer and the push rod. Characterized in that the distal end portion of the push rod includes a push rod adapted to be located proximate to the luminal prosthesis so that a lumen prosthesis can be positioned. . 【請求項９】 前記押し棒が圧縮バネを有することを特
徴とする請求項８に記載の装置。9. The apparatus according to claim 8, wherein said push bar comprises a compression spring. 【請求項１０】 内腔移植片を配置する装置であって、 近端部、該近端部の反対位置にある遠端部、および該遠
端部に開口すると共に軸方向に延び、前記内腔移植片を
収容して放射状に圧縮された状態で維持する大きさの鞘
通路を有する、長い鞘導入器、並びに前記鞘導入器とは
独立に動き、前記鞘通路内に滑動可能に収容される長い
押し棒であって、近端部分と該近端部分から離れた位置
にある遠端部分とを有し、前記鞘導入器と前記押し棒と
の間の相互滑動によって前記鞘通路の開口部から前記内
腔人工器官を配置することができるように、前記押し棒
の該遠端部分が前記内腔移植片に近接して位置すること
ができるようになっている押し棒を含み、前記押し棒が
バネ部材を有していることを特徴とすること。10. An apparatus for deploying a luminal implant, comprising: a proximal end, a distal end opposite the proximal end, and an axially extending and axially extending opening at the distal end. A long sheath introducer having a sheath passage sized to receive and maintain a radially compressed state for receiving the cavity implant, and a long sleeve introducer that moves independently of the sheath introducer and is slidably received within the sheath passage. An elongated push rod having a proximal end portion and a distal end portion remote from the proximal end portion, the sliding passage between the sheath introducer and the push rod opening the sheath passage. A push rod adapted to allow the distal end portion of the push rod to be positioned proximate to the luminal implant so that the luminal prosthesis can be deployed from a portion thereof. The push rod has a spring member. 【請求項１１】 前記押し棒が圧縮バネを有することを
特徴とする請求項１０に記載の装置。11. The device according to claim 10, wherein the push bar comprises a compression spring. 【請求項１２】 前記押し棒が可撓性のある圧縮可能な
螺旋コイル部材を有していることを特徴とする請求項１
０に記載の装置。12. The push rod of claim 1 including a flexible compressible spiral coil member.
The apparatus according to claim 0. 【請求項１３】 前記押し棒が、さらに、配置中に前記
人工器官を包含し、押し棒と人工器官とが一定の動きで
前記鞘通路開口部から出るようにする包含手段を有する
ことを特徴とする請求項１０に記載の装置。13. The push rod further includes means for containing the prosthesis during deployment, wherein the push rod and the prosthesis exit the sheath passage opening with a constant movement. The apparatus according to claim 10, wherein: 【請求項１４】 内腔移植片を配置する装置であって、 近端部、該近端部の反対位置にある遠端部、および該遠
端部に開口すると共に軸方向に延び、前記内腔移植片を
収容して放射状に圧縮された状態で維持する大きさの鞘
通路を有する、長い鞘導入器、並びに前記鞘導入器とは
独立に動き、前記鞘通路内に滑動可能に収容される長い
押し棒であって、近端部分と該近端部分から離れた位置
にある遠端部分とを有し、前記鞘導入器と前記押し棒と
の間の相互滑動によって前記鞘通路の開口部から前記内
腔人工器官を配置することができるように、前記押し棒
の該遠端部分が前記内腔移植片に近接して位置すること
ができるようになっている押し棒を含み、前記押し棒が
螺旋コイルを有していることを特徴とすること。14. An apparatus for deploying a luminal implant, comprising: a proximal end, a distal end opposite the proximal end, and an opening extending at the distal end and extending axially; A long sheath introducer having a sheath passage sized to receive and maintain a radially compressed state for receiving the cavity implant, and a long sleeve introducer that moves independently of the sheath introducer and is slidably received within the sheath passage. An elongated push rod having a proximal end portion and a distal end portion remote from the proximal end portion, the sliding passage between the sheath introducer and the push rod opening the sheath passage. A push rod adapted to allow the distal end portion of the push rod to be positioned proximate to the luminal implant so that the luminal prosthesis can be deployed from a portion thereof; The push rod has a helical coil. 【請求項１５】 前記押し棒の前記遠端部分であって前
記鞘通路に近接する位置に配されており、配置に先立っ
て前記内腔人工器官をその内部に入れる包含手段をさら
に有している、請求項１４に記載の装置。15. The push rod further includes a containment means disposed at the distal end portion of the push rod and adjacent to the sheath passageway and for placing the luminal prosthesis therein prior to deployment. The apparatus of claim 14, wherein
JP2000291056A 1999-09-24 2000-09-25 Transfer apparatus for lumen artificial organ Pending JP2001157681A (en)

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US09/405,562 US6287315B1 (en) 1995-10-30 1999-09-24 Apparatus for delivering an endoluminal prosthesis
US09/405562 1999-09-24

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2009523543A (en) * 2006-01-18 2009-06-25 ウィリアム・エイ・クック・オーストラリア・プロプライエタリー・リミテッド Intracavity delivery device
JP2011087943A (en) * 1996-06-20 2011-05-06 Vascutek Ltd Repair by prosthesis of passage in living body

Families Citing this family (286)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6287315B1 (en) * 1995-10-30 2001-09-11 World Medical Manufacturing Corporation Apparatus for delivering an endoluminal prosthesis
AU723247B2 (en) * 1996-02-28 2000-08-24 Bard Peripheral Vascular, Inc. Flanged graft for end-to-side anastomosis
US6273912B1 (en) * 1996-02-28 2001-08-14 Impra, Inc. Flanged graft for end-to-side anastomosis
US5961545A (en) * 1997-01-17 1999-10-05 Meadox Medicals, Inc. EPTFE graft-stent composite device
GB9709967D0 (en) 1997-05-17 1997-07-09 Harris Peter L Prosthetic grafts
US7520890B2 (en) * 1998-01-26 2009-04-21 Phillips Peter W Reinforced graft and method of deployment
US7491232B2 (en) * 1998-09-18 2009-02-17 Aptus Endosystems, Inc. Catheter-based fastener implantation apparatus and methods with implantation force resolution
US7591842B2 (en) * 1998-03-13 2009-09-22 Aptus Endosystems, Inc. Endovascular prosthesis with suture holder
US8075570B2 (en) * 2001-11-28 2011-12-13 Aptus Endosystems, Inc. Intraluminal prosthesis attachment systems and methods
US7736377B1 (en) * 1998-08-03 2010-06-15 Anson Medical Limited Devices and methods for the repair of arteries
EP1121057A1 (en) * 1998-09-18 2001-08-08 United States Surgical Corporation Endovascular fastener applicator
US6261316B1 (en) 1999-03-11 2001-07-17 Endologix, Inc. Single puncture bifurcation graft deployment system
US20050222665A1 (en) * 1999-04-23 2005-10-06 Ernest Aranyi Endovascular fastener applicator
US7416554B2 (en) 2002-12-11 2008-08-26 Usgi Medical Inc Apparatus and methods for forming and securing gastrointestinal tissue folds
GB2359024A (en) 2000-02-09 2001-08-15 Anson Medical Ltd Fixator for arteries
US6974468B2 (en) * 2001-02-28 2005-12-13 Scimed Life Systems, Inc. Filter retrieval catheter
US6761733B2 (en) 2001-04-11 2004-07-13 Trivascular, Inc. Delivery system and method for bifurcated endovascular graft
US6733521B2 (en) 2001-04-11 2004-05-11 Trivascular, Inc. Delivery system and method for endovascular graft
US6767359B2 (en) 2001-09-28 2004-07-27 Ethicon, Inc. Prosthesis for the repair of thoracic or abdominal aortic aneurysms and method therefor
US20060292206A1 (en) 2001-11-26 2006-12-28 Kim Steven W Devices and methods for treatment of vascular aneurysms
US7828838B2 (en) * 2001-11-28 2010-11-09 Aptus Endosystems, Inc. Devices, systems, and methods for prosthesis delivery and implantation, including a prosthesis assembly
US20070073389A1 (en) 2001-11-28 2007-03-29 Aptus Endosystems, Inc. Endovascular aneurysm devices, systems, and methods
US7147657B2 (en) * 2003-10-23 2006-12-12 Aptus Endosystems, Inc. Prosthesis delivery systems and methods
US8231639B2 (en) 2001-11-28 2012-07-31 Aptus Endosystems, Inc. Systems and methods for attaching a prosthesis within a body lumen or hollow organ
US9320503B2 (en) 2001-11-28 2016-04-26 Medtronic Vascular, Inc. Devices, system, and methods for guiding an operative tool into an interior body region
US20050177180A1 (en) 2001-11-28 2005-08-11 Aptus Endosystems, Inc. Devices, systems, and methods for supporting tissue and/or structures within a hollow body organ
JP4405262B2 (en) * 2001-11-28 2010-01-27 アプタス エンドシステムズ， インコーポレイテッド Intravascular aneurysm repair system
US20050070992A1 (en) 2001-11-28 2005-03-31 Aptus Endosystems, Inc. Prosthesis systems and methods sized and configured for the receipt and retention of fasteners
US20100016943A1 (en) 2001-12-20 2010-01-21 Trivascular2, Inc. Method of delivering advanced endovascular graft
US7147661B2 (en) 2001-12-20 2006-12-12 Boston Scientific Santa Rosa Corp. Radially expandable stent
US7070613B2 (en) * 2002-01-04 2006-07-04 Boston Scientific Scimed, Inc. Non-compliant balloon with compliant top-layer to protect coated stents during expansion
US20030163144A1 (en) * 2002-02-28 2003-08-28 Weadock Kevin S. Sponge for creating an anastomosis between vessels
AU2003221090C1 (en) * 2002-03-28 2009-11-05 Bridgestone Corporation Tissue engineering scaffold material, artificial vessel, cuff member and coating for implants
US8721713B2 (en) 2002-04-23 2014-05-13 Medtronic, Inc. System for implanting a replacement valve
DE10221076A1 (en) 2002-05-11 2003-11-27 Ruesch Willy Gmbh stent
US11890181B2 (en) 2002-07-22 2024-02-06 Tmt Systems, Inc. Percutaneous endovascular apparatus for repair of aneurysms and arterial blockages
US20040133219A1 (en) * 2002-07-29 2004-07-08 Peter Forsell Multi-material constriction device for forming stoma opening
US20060094926A1 (en) * 2002-07-29 2006-05-04 Peter Forsell Multi-material penis constriction device
WO2004011051A1 (en) 2002-07-29 2004-02-05 Potencia Medical Ag Durable implant
US20040034275A1 (en) 2002-07-29 2004-02-19 Peter Forsell Multi-material incontinence treatment constriction device
US7264631B2 (en) * 2002-09-16 2007-09-04 Scimed Life Systems, Inc. Devices and methods for AAA management
US20040116997A1 (en) 2002-09-20 2004-06-17 Taylor Charles S. Stent-graft with positioning anchor
US7481821B2 (en) 2002-11-12 2009-01-27 Thomas J. Fogarty Embolization device and a method of using the same
ITRM20020596A1 (en) * 2002-11-27 2004-05-28 Mauro Ferrari IMPLANT VASCULAR PROSTHESIS WITH COMBINED, LAPAROSCOPIC AND ENDOVASCULAR TECHNIQUES, FOR THE TREATMENT OF ABDOMINAL AORTIC ANEURYSMS, AND OPERATIONAL EQUIPMENT FOR THE RELEASE OF A PROSTHESIS EQUIPPED WITH ANCHORING STENTS.
US7025791B2 (en) 2002-12-02 2006-04-11 Gi Dynamics, Inc. Bariatric sleeve
US7695446B2 (en) 2002-12-02 2010-04-13 Gi Dynamics, Inc. Methods of treatment using a bariatric sleeve
US7608114B2 (en) 2002-12-02 2009-10-27 Gi Dynamics, Inc. Bariatric sleeve
US7122058B2 (en) 2002-12-02 2006-10-17 Gi Dynamics, Inc. Anti-obesity devices
US7678068B2 (en) 2002-12-02 2010-03-16 Gi Dynamics, Inc. Atraumatic delivery devices
US7766973B2 (en) 2005-01-19 2010-08-03 Gi Dynamics, Inc. Eversion resistant sleeves
US7942884B2 (en) 2002-12-11 2011-05-17 Usgi Medical, Inc. Methods for reduction of a gastric lumen
US7942898B2 (en) 2002-12-11 2011-05-17 Usgi Medical, Inc. Delivery systems and methods for gastric reduction
US9125733B2 (en) 2003-01-14 2015-09-08 The Cleveland Clinic Foundation Branched vessel endoluminal device
US7407509B2 (en) 2003-01-14 2008-08-05 The Cleveland Clinic Foundation Branched vessel endoluminal device with fenestration
AU2004206815C1 (en) * 2003-01-14 2008-05-29 The Cleveland Clinic Foundation Branched vessel endoluminal device
US7763045B2 (en) 2003-02-11 2010-07-27 Cook Incorporated Removable vena cava filter
US20040260382A1 (en) 2003-02-12 2004-12-23 Fogarty Thomas J. Intravascular implants and methods of using the same
WO2004087014A2 (en) * 2003-03-28 2004-10-14 Gi Dynamics, Inc. Anti-obesity devices
US20040249362A1 (en) * 2003-03-28 2004-12-09 Gi Dynamics, Inc. Enzyme sleeve
US8109987B2 (en) 2003-04-14 2012-02-07 Tryton Medical, Inc. Method of treating a lumenal bifurcation
US7758630B2 (en) 2003-04-14 2010-07-20 Tryton Medical, Inc. Helical ostium support for treating vascular bifurcations
US7717953B2 (en) 2004-10-13 2010-05-18 Tryton Medical, Inc. Delivery system for placement of prosthesis at luminal OS
US7481834B2 (en) 2003-04-14 2009-01-27 Tryton Medical, Inc. Stent for placement at luminal os
US8083791B2 (en) 2003-04-14 2011-12-27 Tryton Medical, Inc. Method of treating a lumenal bifurcation
US7731747B2 (en) 2003-04-14 2010-06-08 Tryton Medical, Inc. Vascular bifurcation prosthesis with multiple thin fronds
US7972372B2 (en) 2003-04-14 2011-07-05 Tryton Medical, Inc. Kit for treating vascular bifurcations
US7387645B2 (en) * 2003-04-25 2008-06-17 Medtronic Vascular, Inc. Cellular therapy to heal vascular tissue
US7604660B2 (en) 2003-05-01 2009-10-20 Merit Medical Systems, Inc. Bifurcated medical appliance delivery apparatus and method
US20050015110A1 (en) 2003-07-18 2005-01-20 Fogarty Thomas J. Embolization device and a method of using the same
US9198786B2 (en) 2003-09-03 2015-12-01 Bolton Medical, Inc. Lumen repair device with capture structure
US20070198078A1 (en) 2003-09-03 2007-08-23 Bolton Medical, Inc. Delivery system and method for self-centering a Proximal end of a stent graft
US20080264102A1 (en) 2004-02-23 2008-10-30 Bolton Medical, Inc. Sheath Capture Device for Stent Graft Delivery System and Method for Operating Same
US11596537B2 (en) 2003-09-03 2023-03-07 Bolton Medical, Inc. Delivery system and method for self-centering a proximal end of a stent graft
US8292943B2 (en) 2003-09-03 2012-10-23 Bolton Medical, Inc. Stent graft with longitudinal support member
US8500792B2 (en) 2003-09-03 2013-08-06 Bolton Medical, Inc. Dual capture device for stent graft delivery system and method for capturing a stent graft
US11259945B2 (en) 2003-09-03 2022-03-01 Bolton Medical, Inc. Dual capture device for stent graft delivery system and method for capturing a stent graft
US7763063B2 (en) 2003-09-03 2010-07-27 Bolton Medical, Inc. Self-aligning stent graft delivery system, kit, and method
US7101396B2 (en) * 2003-10-06 2006-09-05 3F Therapeutics, Inc. Minimally invasive valve replacement system
US7413573B2 (en) 2003-10-10 2008-08-19 William A. Cook Australia Pty. Ltd. Fenestrated stent grafts
JP4406649B2 (en) * 2003-10-10 2010-02-03 ザ クリーブランド クリニック ファウンデイション Intraluminal prosthesis for interconnection module related applications
US20050149166A1 (en) * 2003-11-08 2005-07-07 Schaeffer Darin G. Branch vessel prosthesis with anchoring device and method
JP4669480B2 (en) 2003-12-09 2011-04-13 ジーアイ・ダイナミックス・インコーポレーテッド Intestinal sleeve
US8057420B2 (en) 2003-12-09 2011-11-15 Gi Dynamics, Inc. Gastrointestinal implant with drawstring
US8048140B2 (en) * 2004-03-31 2011-11-01 Cook Medical Technologies Llc Fenestrated intraluminal stent system
ATE491416T1 (en) 2004-03-31 2011-01-15 Cook Inc STENT DEPOSITION DEVICE
DK1737383T3 (en) 2004-04-16 2015-01-12 Cook Medical Technologies Llc Removable VENA CAVA FILTER by bearers FOR IMPROVED COLLECTION AND FEED
DE602005017599D1 (en) 2004-04-16 2009-12-24 Cook William Europ REMOVABLE VENA CAVA FILTER WITH ANCHORED HOOKS LAYING DOWN IN FOLDED CONDITION
ATE491409T1 (en) 2004-04-16 2011-01-15 Cook Inc REMOVABLE VENA CAVA FILTER WITH ANCHORING DEVICE FOR REDUCED TRAUMA
DE602005027189D1 (en) 2004-04-16 2011-05-12 Cook William Europ REMOVABLE VENA CAVA FILTER FOR REDUCING TRAUMATA IN THE FOLDED CONDITION
US7559925B2 (en) 2006-09-15 2009-07-14 Acclarent Inc. Methods and devices for facilitating visualization in a surgical environment
US7419497B2 (en) 2004-04-21 2008-09-02 Acclarent, Inc. Methods for treating ethmoid disease
US7462175B2 (en) 2004-04-21 2008-12-09 Acclarent, Inc. Devices, systems and methods for treating disorders of the ear, nose and throat
US8894614B2 (en) 2004-04-21 2014-11-25 Acclarent, Inc. Devices, systems and methods useable for treating frontal sinusitis
US20060063973A1 (en) 2004-04-21 2006-03-23 Acclarent, Inc. Methods and apparatus for treating disorders of the ear, nose and throat
US8932276B1 (en) 2004-04-21 2015-01-13 Acclarent, Inc. Shapeable guide catheters and related methods
US8864787B2 (en) 2004-04-21 2014-10-21 Acclarent, Inc. Ethmoidotomy system and implantable spacer devices having therapeutic substance delivery capability for treatment of paranasal sinusitis
US8747389B2 (en) 2004-04-21 2014-06-10 Acclarent, Inc. Systems for treating disorders of the ear, nose and throat
US9554691B2 (en) 2004-04-21 2017-01-31 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US8702626B1 (en) 2004-04-21 2014-04-22 Acclarent, Inc. Guidewires for performing image guided procedures
US8764729B2 (en) 2004-04-21 2014-07-01 Acclarent, Inc. Frontal sinus spacer
US9351750B2 (en) 2004-04-21 2016-05-31 Acclarent, Inc. Devices and methods for treating maxillary sinus disease
US20060004323A1 (en) 2004-04-21 2006-01-05 Exploramed Nc1, Inc. Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures
US9399121B2 (en) 2004-04-21 2016-07-26 Acclarent, Inc. Systems and methods for transnasal dilation of passageways in the ear, nose or throat
US20070208252A1 (en) 2004-04-21 2007-09-06 Acclarent, Inc. Systems and methods for performing image guided procedures within the ear, nose, throat and paranasal sinuses
US10188413B1 (en) 2004-04-21 2019-01-29 Acclarent, Inc. Deflectable guide catheters and related methods
US20070167682A1 (en) 2004-04-21 2007-07-19 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US7803150B2 (en) 2004-04-21 2010-09-28 Acclarent, Inc. Devices, systems and methods useable for treating sinusitis
US9089258B2 (en) 2004-04-21 2015-07-28 Acclarent, Inc. Endoscopic methods and devices for transnasal procedures
US7654997B2 (en) 2004-04-21 2010-02-02 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitus and other disorders of the ears, nose and/or throat
US20190314620A1 (en) 2004-04-21 2019-10-17 Acclarent, Inc. Apparatus and methods for dilating and modifying ostia of paranasal sinuses and other intranasal or paranasal structures
US9101384B2 (en) 2004-04-21 2015-08-11 Acclarent, Inc. Devices, systems and methods for diagnosing and treating sinusitis and other disorders of the ears, Nose and/or throat
US7717951B2 (en) * 2004-05-06 2010-05-18 Cook Incorporated Delivery system that facilitates visual inspection of an intraluminal medical device
US8257394B2 (en) 2004-05-07 2012-09-04 Usgi Medical, Inc. Apparatus and methods for positioning and securing anchors
US8048145B2 (en) 2004-07-22 2011-11-01 Endologix, Inc. Graft systems having filling structures supported by scaffolds and methods for their use
US20060064064A1 (en) * 2004-09-17 2006-03-23 Jang G D Two-step/dual-diameter balloon angioplasty catheter for bifurcation and side-branch vascular anatomy
WO2006034062A1 (en) * 2004-09-17 2006-03-30 Gi Dynamics, Inc. Gastrointestinal anchor
US8845676B2 (en) 2004-09-22 2014-09-30 Micro Therapeutics Micro-spiral implantation device
WO2006032289A1 (en) 2004-09-22 2006-03-30 Dendron Gmbh Medical implant
DK1802252T3 (en) 2004-09-27 2011-10-17 Cook Inc Interchangeable vena cava filter
US9211181B2 (en) * 2004-11-19 2015-12-15 Pulmonx Corporation Implant loading device and system
US20060161241A1 (en) * 2005-01-14 2006-07-20 Denise Barbut Methods and devices for treating aortic atheroma
EP1838381B1 (en) * 2005-01-18 2019-04-17 Acclarent, Inc. Systems for treating disorders of the ear, nose and throat
US7771382B2 (en) * 2005-01-19 2010-08-10 Gi Dynamics, Inc. Resistive anti-obesity devices
CA2593670A1 (en) * 2005-01-21 2006-07-27 Gen4 Llc. Modular stent graft employing bifurcated graft and leg locking stent elements
US20080188803A1 (en) * 2005-02-03 2008-08-07 Jang G David Triple-profile balloon catheter
US7491225B2 (en) * 2005-02-16 2009-02-17 Boston Scientific Scimed, Inc. System and method for deploying a drug-eluting external body and tissue scaffold
EP1879520B1 (en) 2005-05-09 2013-03-13 Angiomed GmbH & Co. Medizintechnik KG Implant delivery device
US8702744B2 (en) * 2005-05-09 2014-04-22 Nexeon Medsystems, Inc. Apparatus and methods for renal stenting
US7914569B2 (en) 2005-05-13 2011-03-29 Medtronics Corevalve Llc Heart valve prosthesis and methods of manufacture and use
US7955372B2 (en) * 2005-06-01 2011-06-07 Board Of Trustees Of The Leland Stanford Junior University Endoluminal delivery system
US7976488B2 (en) 2005-06-08 2011-07-12 Gi Dynamics, Inc. Gastrointestinal anchor compliance
US8951225B2 (en) 2005-06-10 2015-02-10 Acclarent, Inc. Catheters with non-removable guide members useable for treatment of sinusitis
US8709069B2 (en) 2005-07-01 2014-04-29 C. R. Bard, Inc. Flanged graft with trim lines
EP1903985A4 (en) 2005-07-07 2010-04-28 Nellix Inc Systems and methods for endovascular aneurysm treatment
WO2007022496A2 (en) * 2005-08-19 2007-02-22 Icon Medical Corp. Medical device deployment instrument
CN101466316B (en) 2005-10-20 2012-06-27 阿普特斯内***公司 Devices systems and methods for prosthesis delivery and implantation including the use of a fastener tool
US8292827B2 (en) 2005-12-12 2012-10-23 Boston Scientific Scimed, Inc. Micromachined medical devices
JP5181211B2 (en) * 2005-12-23 2013-04-10 クック・メディカル・テクノロジーズ・リミテッド・ライアビリティ・カンパニー Trigger wire release mechanism and introducer for prosthesis including the same
US20070179599A1 (en) * 2006-01-31 2007-08-02 Icon Medical Corp. Vascular protective device
US8518098B2 (en) 2006-02-21 2013-08-27 Cook Medical Technologies Llc Split sheath deployment system
US20070208405A1 (en) * 2006-03-06 2007-09-06 Boston Scientific Scimed, Inc. Stent delivery catheter
US20080114435A1 (en) * 2006-03-07 2008-05-15 Med Institute, Inc. Flexible delivery system
US8777979B2 (en) 2006-04-17 2014-07-15 Covidien Lp System and method for mechanically positioning intravascular implants
US8864790B2 (en) 2006-04-17 2014-10-21 Covidien Lp System and method for mechanically positioning intravascular implants
CA2649705C (en) * 2006-04-19 2015-12-01 William A. Cook Australia Pty. Ltd Twin bifurcated stent graft
US20070276484A1 (en) * 2006-05-26 2007-11-29 Insertion, Llc Method and apparatus for insertion of a flexible implant into the human body
US7819836B2 (en) * 2006-06-23 2010-10-26 Gi Dynamics, Inc. Resistive anti-obesity devices
US8870916B2 (en) 2006-07-07 2014-10-28 USGI Medical, Inc Low profile tissue anchors, tissue anchor systems, and methods for their delivery and use
US10004584B2 (en) 2006-07-10 2018-06-26 First Quality Hygienic, Inc. Resilient intravaginal device
US10219884B2 (en) 2006-07-10 2019-03-05 First Quality Hygienic, Inc. Resilient device
US7717892B2 (en) 2006-07-10 2010-05-18 Mcneil-Ppc, Inc. Method of treating urinary incontinence
US8613698B2 (en) 2006-07-10 2013-12-24 Mcneil-Ppc, Inc. Resilient device
JP5490533B2 (en) 2006-07-10 2014-05-14 マクニール−ピーピーシー・インコーポレイテッド Elastic device
US9820688B2 (en) 2006-09-15 2017-11-21 Acclarent, Inc. Sinus illumination lightwire device
US9339632B2 (en) 2006-09-27 2016-05-17 Boston Scientific Scimed, Inc. Catheter shaft designs
US20080109055A1 (en) * 2006-11-02 2008-05-08 Sage Medical Technologies, Inc. Implant for aortic dissection and methods of use
US8801647B2 (en) 2007-02-22 2014-08-12 Gi Dynamics, Inc. Use of a gastrointestinal sleeve to treat bariatric surgery fistulas and leaks
CA2679898C (en) 2007-03-05 2014-11-18 Alon Shalev Multi-component expandable supportive bifurcated endoluminal grafts and methods for using same
JP5249249B2 (en) 2007-03-13 2013-07-31 コヴィディエン リミテッド パートナーシップ Implant including a coil and a stretch resistant member
CN101677821B (en) 2007-03-13 2014-05-14 泰科保健集团有限合伙公司 Implant and mandrel
US7806917B2 (en) * 2007-04-17 2010-10-05 Medtronic Vascular, Inc. Stent graft fixation system and method
US7981148B2 (en) 2007-05-16 2011-07-19 Boston Scientific Scimed, Inc. Stent delivery catheter
US9119742B2 (en) * 2007-07-16 2015-09-01 Cook Medical Technologies Llc Prosthesis delivery and deployment device
US8226701B2 (en) 2007-09-26 2012-07-24 Trivascular, Inc. Stent and delivery system for deployment thereof
US8663309B2 (en) 2007-09-26 2014-03-04 Trivascular, Inc. Asymmetric stent apparatus and method
US8066755B2 (en) 2007-09-26 2011-11-29 Trivascular, Inc. System and method of pivoted stent deployment
AU2008363361A1 (en) * 2007-10-03 2010-06-10 The General Hospital Corporation Photochemical tissue bonding
EP2194921B1 (en) 2007-10-04 2018-08-29 TriVascular, Inc. Modular vascular graft for low profile percutaneous delivery
US8328861B2 (en) 2007-11-16 2012-12-11 Trivascular, Inc. Delivery system and method for bifurcated graft
US8083789B2 (en) 2007-11-16 2011-12-27 Trivascular, Inc. Securement assembly and method for expandable endovascular device
US20090157048A1 (en) * 2007-12-18 2009-06-18 Boston Scientific Scimed, Inc. Spiral cut hypotube
US8002816B2 (en) * 2007-12-21 2011-08-23 Cleveland Clinic Foundation Prosthesis for implantation in aorta and method of using same
US9226813B2 (en) 2007-12-26 2016-01-05 Cook Medical Technologies Llc Low profile non-symmetrical stent
US9180030B2 (en) 2007-12-26 2015-11-10 Cook Medical Technologies Llc Low profile non-symmetrical stent
GB2476451A (en) 2009-11-19 2011-06-29 Cook William Europ Stent Graft
US8574284B2 (en) 2007-12-26 2013-11-05 Cook Medical Technologies Llc Low profile non-symmetrical bare alignment stents with graft
US8246672B2 (en) 2007-12-27 2012-08-21 Cook Medical Technologies Llc Endovascular graft with separately positionable and removable frame units
US8460213B2 (en) * 2008-01-03 2013-06-11 Boston Scientific Scimed, Inc. Cut tubular members for a medical device and methods for making and using the same
US8157853B2 (en) 2008-01-24 2012-04-17 Medtronic, Inc. Delivery systems and methods of implantation for prosthetic heart valves
EP3572044B1 (en) 2008-01-24 2021-07-28 Medtronic, Inc. Stents for prosthetic heart valves
US9149358B2 (en) * 2008-01-24 2015-10-06 Medtronic, Inc. Delivery systems for prosthetic heart valves
US8221494B2 (en) 2008-02-22 2012-07-17 Endologix, Inc. Apparatus and method of placement of a graft or graft system
US20090234430A1 (en) * 2008-03-17 2009-09-17 James Fleming Weave modification for increased durability in graft material
CA2721950A1 (en) 2008-04-25 2009-10-29 Nellix, Inc. Stent graft delivery system
US20100049294A1 (en) 2008-06-04 2010-02-25 Zukowski Stanislaw L Controlled deployable medical device and method of making the same
AU2009255613B2 (en) 2008-06-04 2013-09-19 W. L. Gore & Associates, Inc. Controlled deployable medical device and method of making the same
AU2009256084A1 (en) 2008-06-04 2009-12-10 Nellix, Inc. Sealing apparatus and methods of use
CN107961098A (en) 2008-06-30 2018-04-27 波顿医疗公司 System and method for abdominal aneurvsm
JP5134729B2 (en) 2008-07-01 2013-01-30 エンドロジックス、インク Catheter system
US7927350B2 (en) * 2008-09-16 2011-04-19 Salviac Limited Plaque liberating device
AU2009293312B2 (en) 2008-09-18 2015-07-09 Acclarent, Inc. Methods and apparatus for treating disorders of the ear nose and throat
EP2349086B1 (en) 2008-10-16 2017-03-22 Medtronic Vascular, Inc. Devices and systems for endovascular staple and/or prosthesis delivery and implantation
US8246648B2 (en) 2008-11-10 2012-08-21 Cook Medical Technologies Llc Removable vena cava filter with improved leg
US8886636B2 (en) * 2008-12-23 2014-11-11 Yahoo! Inc. Context transfer in search advertising
CN106551740B (en) 2009-03-13 2020-03-27 波顿医疗公司 System and method for deploying an endoluminal prosthesis at a surgical site
US8945202B2 (en) 2009-04-28 2015-02-03 Endologix, Inc. Fenestrated prosthesis
US8870938B2 (en) 2009-06-23 2014-10-28 Endospan Ltd. Vascular prostheses for treating aneurysms
US9095464B2 (en) 2009-06-29 2015-08-04 Cook Medical Technologies Llc Slotted pusher rod for flexible delivery system
US8366763B2 (en) 2009-07-02 2013-02-05 Tryton Medical, Inc. Ostium support for treating vascular bifurcations
US9095456B2 (en) 2009-10-13 2015-08-04 Cook Medical Technologies Llc Paraplegia prevention stent graft
US9034027B2 (en) 2009-10-13 2015-05-19 Cook Medical Technologies Llc Paraplegia prevention stent graft
US9757263B2 (en) 2009-11-18 2017-09-12 Cook Medical Technologies Llc Stent graft and introducer assembly
DE102009055969A1 (en) * 2009-11-27 2011-06-01 Transcatheter Technologies Gmbh Device and set for folding or unfolding a medical implant and method
US20110276078A1 (en) 2009-12-30 2011-11-10 Nellix, Inc. Filling structure for a graft system and methods of use
US9468517B2 (en) 2010-02-08 2016-10-18 Endospan Ltd. Thermal energy application for prevention and management of endoleaks in stent-grafts
EP3685807A1 (en) * 2010-06-24 2020-07-29 Cardinal Health Switzerland 515 GmbH Apparatus for and method of pulling a tensile member from a medical device
WO2012023981A2 (en) * 2010-08-17 2012-02-23 St. Jude Medical, Inc. Tip for medical implant delivery system
US9155492B2 (en) 2010-09-24 2015-10-13 Acclarent, Inc. Sinus illumination lightwire device
JP6261339B2 (en) 2010-11-02 2018-01-17 エンドロジックス、インク Apparatus and method for placement of a graft or graft system
US8535371B2 (en) * 2010-11-15 2013-09-17 Endovascular Development AB Method of positioning a tubular element in a blood vessel of a person
US9707108B2 (en) 2010-11-24 2017-07-18 Tryton Medical, Inc. Support for treating vascular bifurcations
WO2012092352A1 (en) * 2010-12-30 2012-07-05 Cook Medical Technologies Llc Occlusion device
US10022212B2 (en) 2011-01-13 2018-07-17 Cook Medical Technologies Llc Temporary venous filter with anti-coagulant delivery method
US8801768B2 (en) 2011-01-21 2014-08-12 Endologix, Inc. Graft systems having semi-permeable filling structures and methods for their use
US9526638B2 (en) 2011-02-03 2016-12-27 Endospan Ltd. Implantable medical devices constructed of shape memory material
CN103561807B (en) 2011-03-01 2015-11-25 恩朵罗杰克斯股份有限公司 Conduit system and using method thereof
US8821529B2 (en) 2011-03-25 2014-09-02 Aga Medical Corporation Device and method for occluding a septal defect
US10201336B2 (en) * 2011-03-25 2019-02-12 St. Jude Medical, Cardiology Division, Inc. Device and method for delivering a vascular device
WO2012139054A1 (en) 2011-04-06 2012-10-11 Endologix, Inc. Method and system for endovascular aneurysm treatment
EP3583916B1 (en) 2011-04-28 2023-12-06 Cook Medical Technologies LLC Apparatus for facilitating deployment of an endoluminal prosthesis
US9101507B2 (en) 2011-05-18 2015-08-11 Ralph F. Caselnova Apparatus and method for proximal-to-distal endoluminal stent deployment
US9289282B2 (en) 2011-05-31 2016-03-22 Edwards Lifesciences Corporation System and method for treating valve insufficiency or vessel dilatation
WO2013030818A2 (en) 2011-08-28 2013-03-07 Endospan Ltd. Stent-grafts with post-deployment variable axial and radial displacement
WO2013065040A1 (en) 2011-10-30 2013-05-10 Endospan Ltd. Triple-collar stent-graft
US9579104B2 (en) 2011-11-30 2017-02-28 Covidien Lp Positioning and detaching implants
EP2785277B1 (en) 2011-12-04 2017-04-05 Endospan Ltd. Branched stent-graft system
US9011480B2 (en) 2012-01-20 2015-04-21 Covidien Lp Aneurysm treatment coils
WO2013116860A1 (en) * 2012-02-02 2013-08-08 Inceptus Medical LLC Aneurysm graft devices and methods
US9072624B2 (en) 2012-02-23 2015-07-07 Covidien Lp Luminal stenting
US20130226278A1 (en) 2012-02-23 2013-08-29 Tyco Healthcare Group Lp Methods and apparatus for luminal stenting
US9687245B2 (en) 2012-03-23 2017-06-27 Covidien Lp Occlusive devices and methods of use
US8992595B2 (en) 2012-04-04 2015-03-31 Trivascular, Inc. Durable stent graft with tapered struts and stable delivery methods and devices
US9498363B2 (en) 2012-04-06 2016-11-22 Trivascular, Inc. Delivery catheter for endovascular device
WO2013154749A1 (en) 2012-04-12 2013-10-17 Bolton Medical, Inc. Vascular prosthetic delivery device and method of use
US9078659B2 (en) 2012-04-23 2015-07-14 Covidien Lp Delivery system with hooks for resheathability
EP2841024B1 (en) 2012-04-26 2017-05-03 Tryton Medical, Inc. Support for treating vascular bifurcations
US9770350B2 (en) 2012-05-15 2017-09-26 Endospan Ltd. Stent-graft with fixation elements that are radially confined for delivery
US9724222B2 (en) 2012-07-20 2017-08-08 Covidien Lp Resheathable stent delivery system
US9993360B2 (en) 2013-01-08 2018-06-12 Endospan Ltd. Minimization of stent-graft migration during implantation
DE102013101334A1 (en) * 2013-02-11 2014-08-14 Acandis Gmbh & Co. Kg Intravascular functional element and method for its production, use of a salt bath for heat treatment
CN105120910B (en) 2013-03-14 2019-04-12 恩朵罗杰克斯股份有限公司 Method for material to be formed in situ in medical instrument
US9439751B2 (en) 2013-03-15 2016-09-13 Bolton Medical, Inc. Hemostasis valve and delivery systems
US10130500B2 (en) 2013-07-25 2018-11-20 Covidien Lp Methods and apparatus for luminal stenting
US10045867B2 (en) 2013-08-27 2018-08-14 Covidien Lp Delivery of medical devices
US9782186B2 (en) 2013-08-27 2017-10-10 Covidien Lp Vascular intervention system
US10603197B2 (en) 2013-11-19 2020-03-31 Endospan Ltd. Stent system with radial-expansion locking
JP2017500144A (en) * 2013-12-27 2017-01-05 レナルプロ・メディカル・インコーポレーテッドＲｅｎａｌｐｒｏ Ｍｅｄｉｃａｌ，Ｉｎｃ． Device and method for the treatment of acute kidney injury
US9713475B2 (en) 2014-04-18 2017-07-25 Covidien Lp Embolic medical devices
US10959826B2 (en) 2014-10-16 2021-03-30 Cook Medical Technology LLC Support structure for scalloped grafts
BR112017012425A2 (en) 2014-12-18 2018-01-02 Endospan Ltd endovascular stent graft with fatigue resistant lateral tube
GB2534194B (en) 2015-01-16 2017-02-08 Cook Medical Technologies Llc Cone Expanding Collapsible Medical Device
CN107735048B (en) * 2015-02-12 2019-11-12 赫莫迪纳克斯科技有限公司 Aorta implantation material
WO2017004265A1 (en) 2015-06-30 2017-01-05 Endologix, Inc. Locking assembly for coupling guidewire to delivery system
US10512533B1 (en) 2016-02-23 2019-12-24 W. L. Gore & Associates, Inc. Branched graft assembly method in vivo
US10695563B2 (en) 2016-03-28 2020-06-30 CalXStars Business Accelerator, Inc. Orthodontic treatment
US11052247B2 (en) 2016-03-15 2021-07-06 Leonhardt Ventures Llc Skin treatment system
US10646644B2 (en) 2016-03-15 2020-05-12 CalXStars Business Accelerator, Inc. Stimulator, pump and composition
US11185691B2 (en) 2016-03-15 2021-11-30 Leonhardt Ventures Llc Tumor therapy
US11110274B2 (en) 2016-03-15 2021-09-07 Leonhardt Ventures Llc System and method for treating inflammation
US11691007B2 (en) 2016-03-15 2023-07-04 Leonhardt Ventures Llc Bioelectric OPG treatment of cancer
US11167141B2 (en) 2016-03-15 2021-11-09 Leonhardt Ventures Llc Bioelectric blood pressure management
US10960206B2 (en) 2016-03-15 2021-03-30 Leonhardt Ventures Llc Bioelectric stimulator
US11849910B2 (en) 2016-03-15 2023-12-26 Valvublator Inc. Methods, systems, and devices for heart valve decalcification, regeneration, and repair
WO2017192912A1 (en) 2016-05-04 2017-11-09 Renalpro Medical, Inc. Devices and methods for treating acute kidney injury
US11628056B2 (en) 2016-11-22 2023-04-18 Cook Medical Technologies Llc Graft for treating the distal aortic arch and descending aorta in type a patients
EP3329950B1 (en) * 2016-12-01 2019-09-04 Berlin Heart GmbH Cannula, cannula system and blood pump system
US10376396B2 (en) 2017-01-19 2019-08-13 Covidien Lp Coupling units for medical device delivery systems
US11071637B2 (en) 2018-04-12 2021-07-27 Covidien Lp Medical device delivery
US11123209B2 (en) 2018-04-12 2021-09-21 Covidien Lp Medical device delivery
US10786377B2 (en) 2018-04-12 2020-09-29 Covidien Lp Medical device delivery
US11413176B2 (en) 2018-04-12 2022-08-16 Covidien Lp Medical device delivery
US10441449B1 (en) 2018-05-30 2019-10-15 Vesper Medical, Inc. Rotary handle stent delivery system and method
EP3801724A1 (en) 2018-06-05 2021-04-14 Medtronic Vascular Inc. Medical catheter
WO2019236737A1 (en) 2018-06-05 2019-12-12 Medtronic Vascular, Inc. Catheter including slidable push grip
EP3801725A1 (en) 2018-06-05 2021-04-14 Medtronic Vascular Inc. Medical catheter
US10449073B1 (en) 2018-09-18 2019-10-22 Vesper Medical, Inc. Rotary handle stent delivery system and method
US11446488B2 (en) 2019-03-13 2022-09-20 Leonhardt Ventures Llc Kidney treatment
US11471686B2 (en) 2019-03-13 2022-10-18 Leonhardt Ventures Llc Klotho modulation
CN113853178A (en) 2019-03-20 2021-12-28 Inqb8医疗科技有限责任公司 Aortic dissection implant
US11413174B2 (en) 2019-06-26 2022-08-16 Covidien Lp Core assembly for medical device delivery systems
USD957646S1 (en) 2019-08-29 2022-07-12 OrthodontiCell, Inc. Dental mouthpiece
US11219541B2 (en) 2020-05-21 2022-01-11 Vesper Medical, Inc. Wheel lock for thumbwheel actuated device
WO2021252753A1 (en) * 2020-06-11 2021-12-16 Eclipse Regenesis, Inc. Delivery devices for expandable implants and methods therefor
CN112741691B (en) * 2020-12-31 2022-05-13 杭州脉流科技有限公司 Spring coil coiled support release simulation method and device, computer equipment and storage medium
USD1025361S1 (en) 2021-06-11 2024-04-30 OrthodontiCell, Inc. Dental mouthpiece
US11944558B2 (en) 2021-08-05 2024-04-02 Covidien Lp Medical device delivery devices, systems, and methods

Family Cites Families (77)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3878565A (en) 1971-07-14 1975-04-22 Providence Hospital Vascular prosthesis with external pile surface
US4140126A (en) 1977-02-18 1979-02-20 Choudhury M Hasan Method for performing aneurysm repair
US4300244A (en) 1979-09-19 1981-11-17 Carbomedics, Inc. Cardiovascular grafts
US5104399A (en) 1986-12-10 1992-04-14 Endovascular Technologies, Inc. Artificial graft and implantation method
US5275622A (en) * 1983-12-09 1994-01-04 Harrison Medical Technologies, Inc. Endovascular grafting apparatus, system and method and devices for use therewith
US4562596A (en) 1984-04-25 1986-01-07 Elliot Kornberg Aortic graft, device and method for performing an intraluminal abdominal aortic aneurysm repair
US4580568A (en) 1984-10-01 1986-04-08 Cook, Incorporated Percutaneous endovascular stent and method for insertion thereof
US4577631A (en) * 1984-11-16 1986-03-25 Kreamer Jeffry W Aneurysm repair apparatus and method
US4878906A (en) 1986-03-25 1989-11-07 Servetus Partnership Endoprosthesis for repairing a damaged vessel
SU1457921A1 (en) 1987-03-10 1989-02-15 Харьковский научно-исследовательский институт общей и неотложной хирургии Self-fixing prosthesis of blood vessel
US4795458A (en) 1987-07-02 1989-01-03 Regan Barrie F Stent for use following balloon angioplasty
US5127919A (en) 1988-12-14 1992-07-07 Vascutec Corporation Woven vascular graft
JPH067843B2 (en) 1990-02-15 1994-02-02 寛治 井上 Artificial blood vessel with frame
US5354295A (en) * 1990-03-13 1994-10-11 Target Therapeutics, Inc. In an endovascular electrolytically detachable wire and tip for the formation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas
US5123917A (en) 1990-04-27 1992-06-23 Lee Peter Y Expandable intraluminal vascular graft
US5108407A (en) * 1990-06-08 1992-04-28 Rush-Presbyterian St. Luke's Medical Center Method and apparatus for placement of an embolic coil
US5360443A (en) 1990-06-11 1994-11-01 Barone Hector D Aortic graft for repairing an abdominal aortic aneurysm
US5578071A (en) 1990-06-11 1996-11-26 Parodi; Juan C. Aortic graft
US5236447A (en) 1990-06-29 1993-08-17 Nissho Corporation Artificial tubular organ
US5122154A (en) 1990-08-15 1992-06-16 Rhodes Valentine J Endovascular bypass graft
ES2081490T3 (en) 1990-08-28 1996-03-16 Meadox Medicals Inc VASCULAR GRAFT SELF-SUPPORTING FABRIC.
AR246020A1 (en) 1990-10-03 1994-03-30 Hector Daniel Barone Juan Carl A ball device for implanting an intraluminous aortic prosthesis, for repairing aneurysms.
ATE135555T1 (en) 1990-10-09 1996-04-15 Cook Inc PERCUTANE STENT ARRANGEMENT
US5489298A (en) * 1991-01-24 1996-02-06 Autogenics Rapid assembly concentric mating stent, tissue heart valve with enhanced clamping and tissue exposure
US5383925A (en) 1992-09-14 1995-01-24 Meadox Medicals, Inc. Three-dimensional braided soft tissue prosthesis
US5628783A (en) * 1991-04-11 1997-05-13 Endovascular Technologies, Inc. Bifurcated multicapsule intraluminal grafting system and method
US5147370A (en) 1991-06-12 1992-09-15 Mcnamara Thomas O Nitinol stent for hollow body conduits
US5304220A (en) 1991-07-03 1994-04-19 Maginot Thomas J Method and apparatus for implanting a graft prosthesis in the body of a patient
US5151105A (en) 1991-10-07 1992-09-29 Kwan Gett Clifford Collapsible vessel sleeve implant
US5387235A (en) 1991-10-25 1995-02-07 Cook Incorporated Expandable transluminal graft prosthesis for repair of aneurysm
EP0539237A1 (en) 1991-10-25 1993-04-28 Cook Incorporated Expandable transluminal graft prosthesis for repair of aneurysm and method for implanting
US5234437A (en) * 1991-12-12 1993-08-10 Target Therapeutics, Inc. Detachable pusher-vasoocclusion coil assembly with threaded coupling
US5261878A (en) 1992-05-19 1993-11-16 The Regents Of The University Of California Double balloon pediatric ductus arteriosus stent catheter and method of using the same
US5507771A (en) 1992-06-15 1996-04-16 Cook Incorporated Stent assembly
US5342387A (en) 1992-06-18 1994-08-30 American Biomed, Inc. Artificial support for a blood vessel
US5312415A (en) * 1992-09-22 1994-05-17 Target Therapeutics, Inc. Assembly for placement of embolic coils using frictional placement
US5449382A (en) 1992-11-04 1995-09-12 Dayton; Michael P. Minimally invasive bioactivated endoprosthesis for vessel repair
US5342348A (en) 1992-12-04 1994-08-30 Kaplan Aaron V Method and device for treating and enlarging body lumens
US5338296A (en) 1993-01-06 1994-08-16 Ethicon, Inc. Catheter and sheath assembly
FR2701869B1 (en) 1993-02-25 1995-06-09 Saint Gobain Vitrage Int Device for distributing powdered solids on the surface of a substrate in order to coat it.
EP0676937B1 (en) 1993-09-30 2004-03-17 Endogad Research PTY Limited Intraluminal graft
DE4334140C2 (en) 1993-10-07 1996-04-18 Angiomed Ag Stent and device with stent
DE69419877T2 (en) 1993-11-04 1999-12-16 Bard Inc C R Fixed vascular prosthesis
WO1995013033A1 (en) 1993-11-08 1995-05-18 Lazarus Harrison M Intraluminal vascular graft and method
DE9319267U1 (en) 1993-12-15 1994-02-24 Vorwerk Dierk Dr Aortic endoprosthesis
US5476506A (en) * 1994-02-08 1995-12-19 Ethicon, Inc. Bi-directional crimped graft
US5609627A (en) * 1994-02-09 1997-03-11 Boston Scientific Technology, Inc. Method for delivering a bifurcated endoluminal prosthesis
US5575817A (en) * 1994-08-19 1996-11-19 Martin; Eric C. Aorto femoral bifurcation graft and method of implantation
US5562727A (en) * 1994-10-07 1996-10-08 Aeroquip Corporation Intraluminal graft and method for insertion thereof
WO1996014808A1 (en) 1994-11-09 1996-05-23 Endotex Interventional Systems, Inc. Delivery catheter and graft for aneurysm repair
US5800521A (en) 1994-11-09 1998-09-01 Endotex Interventional Systems, Inc. Prosthetic graft and method for aneurysm repair
US5814062A (en) * 1994-12-22 1998-09-29 Target Therapeutics, Inc. Implant delivery assembly with expandable coupling/decoupling mechanism
NL9500094A (en) * 1995-01-19 1996-09-02 Industrial Res Bv Y-shaped stent and method of deployment.
US5662675A (en) * 1995-02-24 1997-09-02 Intervascular, Inc. Delivery catheter assembly
US5683449A (en) * 1995-02-24 1997-11-04 Marcade; Jean Paul Modular bifurcated intraluminal grafts and methods for delivering and assembling same
US5643278A (en) * 1995-04-06 1997-07-01 Leocor, Inc. Stent delivery system
US5667523A (en) 1995-04-28 1997-09-16 Impra, Inc. Dual supported intraluminal graft
US5591228A (en) * 1995-05-09 1997-01-07 Edoga; John K. Methods for treating abdominal aortic aneurysms
ATE314022T1 (en) 1995-06-01 2006-01-15 Meadox Medicals Inc IMPLANTABLE INTRALUMINAL PROSTHESIS
US5728131A (en) 1995-06-12 1998-03-17 Endotex Interventional Systems, Inc. Coupling device and method of use
US5769882A (en) * 1995-09-08 1998-06-23 Medtronic, Inc. Methods and apparatus for conformably sealing prostheses within body lumens
US5824037A (en) 1995-10-03 1998-10-20 Medtronic, Inc. Modular intraluminal prostheses construction and methods
US5669924A (en) * 1995-10-26 1997-09-23 Shaknovich; Alexander Y-shuttle stent assembly for bifurcating vessels and method of using the same
US6287315B1 (en) * 1995-10-30 2001-09-11 World Medical Manufacturing Corporation Apparatus for delivering an endoluminal prosthesis
US5591195A (en) 1995-10-30 1997-01-07 Taheri; Syde Apparatus and method for engrafting a blood vessel
US5824040A (en) * 1995-12-01 1998-10-20 Medtronic, Inc. Endoluminal prostheses and therapies for highly variable body lumens
US5824042A (en) * 1996-04-05 1998-10-20 Medtronic, Inc. Endoluminal prostheses having position indicating markers
US5800514A (en) * 1996-05-24 1998-09-01 Meadox Medicals, Inc. Shaped woven tubular soft-tissue prostheses and methods of manufacturing
US5676697A (en) * 1996-07-29 1997-10-14 Cardiovascular Dynamics, Inc. Two-piece, bifurcated intraluminal graft for repair of aneurysm
US6152956A (en) 1997-01-28 2000-11-28 Pierce; George E. Prosthesis for endovascular repair of abdominal aortic aneurysms
US5957949A (en) * 1997-05-01 1999-09-28 World Medical Manufacturing Corp. Percutaneous placement valve stent
US6206888B1 (en) * 1997-10-01 2001-03-27 Scimed Life Systems, Inc. Stent delivery system using shape memory retraction
US6146389A (en) * 1998-04-23 2000-11-14 Boston Scientific Corporation Stent deployment device and method for deploying a stent
US6203550B1 (en) * 1998-09-30 2001-03-20 Medtronic, Inc. Disposable delivery device for endoluminal prostheses
US6368345B1 (en) * 1998-09-30 2002-04-09 Edwards Lifesciences Corporation Methods and apparatus for intraluminal placement of a bifurcated intraluminal garafat
US6197049B1 (en) * 1999-02-17 2001-03-06 Endologix, Inc. Articulating bifurcation graft
US6858034B1 (en) * 1999-05-20 2005-02-22 Scimed Life Systems, Inc. Stent delivery system for prevention of kinking, and method of loading and using same

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2011087943A (en) * 1996-06-20 2011-05-06 Vascutek Ltd Repair by prosthesis of passage in living body
JP2009523543A (en) * 2006-01-18 2009-06-25 ウィリアム・エイ・クック・オーストラリア・プロプライエタリー・リミテッド Intracavity delivery device

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US20020077634A1 (en) 2002-06-20

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